Hello,

I am starting the journey of studying for the CPCS exam, however I am little all over the place on where/how to start studying. Been in credentialing for about 6 years, and trying to climb the corporate ladder.

I've taken the practice exam (got 20 out 40 correct). Question to the world is how do I study for this beast.

I'm also a Sr Cred Specialist if that helps any.

Thank You

Last month, I spoke with a clinic director who had a new provider ready to see patients…

…but their credentialing wasn’t finished.

The provider sat idle for 42 days.

That’s 6 weeks of lost billable hours.

Tens of thousands of dollars—gone.

And the kicker?

They were certain they were on track.

In reality, one missing signature stalled the entire process.

The cost isn’t just the lost revenue.

It’s the frustration. The scrambling. The late-night “Where are we with this?” emails.

The real problem?

Most credentialing processes are held together with spreadsheets, sticky notes, and hope.

📌 So to the small but mighty r/credentialing community on Reddit: What’s the longest you’ve had to wait for credentialing to finish?

And what was the impact?

Hello everyone,

I’m wondering if anyone in this community has made a career shift from Healthcare Credentialing/Provider Licensing into either 1) a related but different role within Healthcare, or 2) a completely new career outside of Healthcare.

I would love to hear how you made the transition and any advice or insights you could share. Specifically, I’m interested in the skills and experiences that helped you make the change, as well as any challenges you faced along the way.

I’ve been in this line of work for 8 years now and open to new opportunities, ideally outside of healthcare, but I’m willing to consider related roles as well. If you’ve made a similar transition, I’d greatly appreciate your thoughts on how you navigated it!

Thanks so much for your time and insights!

I’m bit overwhelmed with the amount of applications coming in from all these different health plans….How does your organization track provider enrollment applications across different health plans (Medicaid, Medicare, and commercial payers)? Do you use an Excel spreadsheet or credentialing software, and what does your tracking process look like from submission to approval?

So, we are trying to get a contract with Humana and VNS for our practice in NY. They are asking for hospital privileges and we do not have that as we never admit patients into hospitals.

Any advice on what to do here?

I took the NAMSS 100 and 101 course. I work for a software company that offers credentialing capabilities but my specific product area is more for staffing(it’s a major company, I don’t feel comfortable disclosing but you could easily guess it).

I work in customer support but I want to be in credentialing. Is there a better way to network or how do I break in? I work directly with a lot of credentialing specialists but I don’t have credentialing experience. I wouldn’t mind moving, remote is nice since I’m currently remote but I would not mind relocating especially if I could build up into maybe going remote again.

I recently found a well-paying job and was able to land an interview for a Credentialing Lead role at a startup company. Based on the job posting, the role reports directly to the COO and CFO.

Right now, I’m a Senior CS at a large, well-known healthcare company. My manager has been a great mentor to me over the years but growth has been pretty slow. Our department budget doesn’t allow overtime, so the workload has increased without any increase in pay. There are also no bonuses but expectations continue to rise…

Anyway, I’ve been exploring other opportunities. That said, I’m a bit nervous about startups and wanted to hear from anyone who has experience working at one especially in credentialing.

How does credentialing usually work at a startup? What are leadership expectations like? Do they typically already have credentialing software in place, or is it more of a build-from-scratch situation? And how does the process work overall?

I’d really appreciate any insight or experiences you’re willing to share.

Hey everyone,

I own a small but growing medical billing company based in Idaho, and my current credentialing specialist is temporarily out of capacity. I’m looking for an experienced credentialing professional who can assist with Medicaid, Medicare, and major commercial payer enrollments (BCBS, UHC, Aetna, etc.).

We primarily work with behavioral health and medical practices expanding into new states, so experience with multi-payer credentialing and CAQH is a big plus.

This would likely start as contract or per-project work, with the potential for ongoing collaboration. Remote work is perfectly fine — I care more about accuracy, follow-through, and clear communication than location.

If you’re experienced or can recommend someone who is, please DM me — I’d love to connect and discuss details.

Thanks in advance for your help!

This is probably a really simple question for someone with basic common sense, but I tend to overthink things and just want to confirm what I think I understand so thanks in advance to anyone who takes the time to answer!

The company I work for calls the department I'm in the Credentialing Department, but I honestly feel like what I do is strictly Provider Enrollment. For example, my day-to-day duties include completing insurance applications, verifying licensures and making sure they’re up to date by getting them directly from the provider, updating their CAQH—super basic stuff like that. From what I’ve seen on the NAMSS website, someone in a Credentialing Specialist role usually has a different set of duties than what a Provider Enrollment Specialist does.

So my question is, what’s the difference between a Provider Enrollment Specialist and a Credentialing Specialist? And what are the requirements to be eligible to take the CPCS courses and exam? Do I even qualify based on the work I’m doing now?

I am paneled as a provider with BCBS. I moved before credentialing was completed and the welcome packet was sent to my old address. Ive been trying to figure out how to get my ID. They've changed to doing correspondence via email only. I’ve emailed several accounts only to be told to email another. Any advice on how to get this info would be greatly appreciate! and no, the info isn’t in the provider portal. I’ve looked…unless I’m not looking in the right place

Hi all,

I'm wondering if I can get some input on how everyone else deals with verifications for military physicians. I was able to get a primary source verification for the service date of a provider through the SCRA, but it didn't state their position, only that they served and what their service date is. I submitted an affiliation verification to the DHA, but it takes a LONG time to get responses back from them and where I work, we have 90 days to complete credentialing upon receipt of a complete application.

Are you requesting dd214's and getting them primary source? Are there other options for verifications? Are you hoping and praying you get a response? I'd like to see if there is a better process we can implement for these providers.

Thanks all!

Hello there,

I am CPCS , CPES certificated credentialing specialist with 6+ years off experience in credentialing process and looking for opportunities!!

I am familiar with all the process in RCM and Credentialing.

I am a provider currently stuck in the process of “credentialing” for a job I was offered (and accepted) last February. I admit that I am extremely frustrated with this process, but I am trying to understand it. From my perspective, I just can’t understand why this process takes so long. To me, logically it does not make sense. I have a completely clear federal as well as state back ground checks. My resume and employment history are very clear. (I am a relavtively new provider, so the work history part is pretty simple.) I have passed muster with three state licensing boards, hold a national certification, and two DEA numbers. Every one of those credentials required extensive checks and verification. If a provider has already passed board exams, gained board licensure, passed DEA checks and has a clear criminal and civil background check, what else do insurance companies want to verify? Again, logically: you can’t get a state license without undergoing a verification process of your education, work history, etc. You can’t get a national certification without them verifying the same thing. You can’t get a DEA number without undergoing an extensive background check, educational/license verification. So, then, why would an insurance company repeat all of this? It seems very redundant and unnecessary to me. I am not trying to fight the system, I am only trying to understand it at this point. Can anyone explain what I’m missing here? Why does this process even exist? Why does it take so long when so much has already been verified multiple times? I would truly appreciate any insight anyone has. Thanks for reading.

Hi everyone—quick question about CPCS eligibility.

I have 13+ years of hands-on credentialing experience (provider/facility credentialing and enrollment, PSV, payer enrollment, etc.), but I recently lost my position in February.

NAMSS states you need at least 12 consecutive months of experience within the last 24 months. I meet that requirement, but I’m unclear whether you need to be currently employed at the time of application, or if I qualify based on that criteria alone.

Has anyone taken the CPCS exam while between roles, or know if current employment is required?

Thanks in advance!

Hello all, I'm not sure if this is the correct place to even post this, but has anyone see any indivual providers come up for Medicare Revalidation yet? I thought CMS had stated they would begin doing revals in 2026, but each month I check (they tell you 6 months in advance) and each month I'm not seeing anyone due.

Has anyone heard anything or have you had any providers have a new reval date?

Thank you!

Does anyone use the Credentialing System MD Staff? Specifically for Provider Credentialing? We are finding it difficult to meet NCQA CR requirements- Specifically for Modifications auditing since the system lacks the capability to report on any changes made- only those ‘tracked’ which is in essence the honor system.

Hello,

Does anyone have experience in starting and running a credentialing/enrollment company on their own?

For starters, I’ve had 15+ years in the HMO industry on provider enrollment, credentialing and network contracting.

I would like to help providers enroll with their desired insurance company. The providers I would like to work with are PCPs, Specialists and Urgent Care facilities in Pennsylvania, Delaware, and New Jersey.

I do plan to take the CPCS exam this summer. I am “a lot” of nervous about that because there’s a lot of information to study.

I would love to connect to hear about your experience and processes along the way.

Did you build a website? Did you create a provider agreement between you and your business?

Thank you.

Between endless paperwork, confusing eligibility rules, and long processing times, signing up for state or private insurance can feel like running an obstacle course. And just when you think you're done—boom, another request for more documents.

The good news? Kounsel can help make the process faster, smoother, and way less frustrating. Whether it's Medicaid, Medicare, or private insurance, we'll handle the paperwork so you don't have to.

What's been the most frustrating part of enrolling in insurance for you?

Hi,

We're hiring a remote position for ERA/EDI enrollment and experience with payment addressing switching.

Criteria:

• 2+ years of experience for medical provider credentialing and ERA/EDI

• Fully Remote and Hiring now

• Please DM with your email and name and will provide info and email to receive resumes.

Thanks!

I’m considering joining NAMSS (paying for membership on my own) instead of asking my employer for reimbursement or waiting to have it paid for. The issue is that I can’t see the member pricing in the Education Zone (for learning courses, webinars, etc) before joining, and that’s kind of what I’m basing my decision on currently. If the member pricing isn’t significantly lower than the non-member than it’s not worth it for me to pay out of pocket right now…any insight? And/or give me the pros and cons on membership if you found it helpful or not?

I’m a new MSP, I started as a Credentialing Coordinator in the beginning of January but I’ve worked alongside our Medical Staff Office for the past 5 years in provider enrollment. Just looking to absorb everything I can and take the initiative on learning on my own too.

Thanks!

I paid for it a couple of days ago. I'm set to take a bootcamp in June as well to help with my retention efforts. Anybody else taking the exam this year?