Credentialing

Hub 01 · Credentialing

3 Roles · 6 Positions

The backbone of provider access.

Credentialing professionals verify and maintain the provider documentation that allows clinicians to participate in VA Community Care Network, TRICARE, CHAMPVA, and commercial payer networks — and the state-level credentialing that operates underneath every federal payer relationship. Strong credentialing keeps providers active in payer networks; weak credentialing means providers earn nothing because their claims won’t be paid.

NCQA

Healthcare Credentialing Standards

URAC

Health Provider Credentialing

CAQH ProView

Universal Provider Datasource

STATE BOARDS

Multi-State Licensure

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About Mendry

Hub 01 · Overview

Six Credentialing roles. One membership philosophy.

Every Mendry DCSP member operates their own business. Mendry does not employ, place, refer, or supervise credentialing professionals. We list independent members so the practices that need them can find them. Your business. Your contracts. Your rates. Your decisions. The six Credentialing roles below cover the full provider access architecture — from Credentialing Specialist daily workflow through Coordinator, Analyst, Manager leadership, Recredentialing Specialist maintenance, and State Medical Board credentialing for multi-state practices. Each role page is built on the same fifteen-point member acknowledgment that governs every Mendry DCSP membership.

The Six Positions

Credentialing Roles in Detail.

Tap any role to read its full page — including the 15-point member acknowledgment, the plain-language teaching block, the 8-step independent contractor roadmap, the income research sources, and the VA CCN / TRICARE / CHAMPVA workflow specific to that role.

Credentialing Specialist

A Credentialing Specialist verifies and maintains the documentation that allows clinicians to participate in VA Community Care Network, TRICARE, CHAMPVA, and commercial payer networks. Every license, every board certification, every malpractice history, every NPI, every CAQH attestation passes through this role. The work is detailed. The work is

Credentialing Coordinator

A Credentialing Coordinator runs the day-to-day workflow of credentialing — moving providers through the credentialing pipeline from initial application to active status with each payer. Where the Credentialing Specialist focuses on verification, the Coordinator focuses on flow: tracking applications, communicating with providers, following up with payers, and ensuring

Credentialing Analyst

A Credentialing Analyst reviews credentialing files for compliance, identifies risk patterns, and ensures the practice’s credentialing operation meets NCQA, URAC, and payer-specific standards before audits happen. The work is analytical. The work catches problems before they become findings. And it is the role that transforms credentialing from operational

Credentialing Manager

A Credentialing Manager runs the credentialing operation — staff, workflow, technology, vendor relationships, and the strategic decisions that determine whether a practice’s credentialing function operates as a competitive advantage or a recurring source of pain. The work is leadership. The work is operational design. And it is the

Recredentialing Specialist

A Recredentialing Specialist manages the cyclical re-verification of every credentialed provider every 36 months — the recredentialing cycle that NCQA, URAC, and most payers require. The work is calendar-driven. The work is predictable. And it is one of the cleanest revenue cycle protections a practice has, because a

State Medical Board Credentialing Specialist

A State Medical Board Credentialing Specialist handles the state-level credentialing that operates underneath every federal payer relationship — state medical license verification, state medical board enrollment, multi-state license maintenance, state-specific medical board requirements, and the Federation Credentials Verification Service (FCVS) workflow that makes multi-state licensure manageable. The work

The Six Positions

The Bodies and Certifications Behind the Role.

Professional bodies and certifications relevant to this specialty. Mendry is a membership organization — it does not issue these credentials, require them for membership, or verify that any member holds them. They are listed here as a reference for credentialing professionals building their independent practice and for the two-hat practices evaluating candidates.

CAQH — Council for Affordable Quality Healthcare

ProView / Universal Provider Datasource. The primary tool for DCSP credentialing professionals managing provider profiles across multiple payers.

NAMSS — National Association Medical Staff Services

Certifying body for the CPCS (Certified Provider Credentialing Specialist) and CPMSM (Certified Professional in Medical Services Management).

NCQA — National Committee for Quality Assurance

Healthcare credentialing standards. NCQA-based credentialing standards govern the 36-month re-credentialing cycle that most payer networks, including CCN, follow.

URAC

Health provider credentialing accreditation. URAC accreditation requires demonstrated credentialing process standards for organizations managing multiple provider relationships.

State Medical Boards

Multi-state licensure. The State Medical Board Liaison role centers on managing licensure with individual state boards across all states where two-hat providers hold credentials.

FCVS — Federation Credentials Verification Service

Managed by the Federation of State Medical Boards. The FCVS workflow is the standard tool for multi-state licensure management in practices operating across multiple states.

Glossary

Every Acronym Used on This Page.

Defined in full on first use above and collected here as the reference backstop.

CAQH

ProView / Universal Provider Datasource. The primary tool for DCSP credentialing professionals managing provider profiles across multiple payers.

MGMA

Medical Group Management Association — professional association and credentialing track for medical practice managers.

CCN

VA Community Care Network — the U.S. Department of Veterans Affairs network through which community providers deliver care to veterans.

NAMSS

National Association Medical Staff Services — the professional body that issues the CPCS and CPMSM certifications.

CHAMPVA

Civilian Health and Medical Program of the Department of Veterans Affairs — a health benefits program for families of certain veterans.

NCQA

National Committee for Quality Assurance — sets healthcare credentialing standards including the 36-month recredentialing cycle requirement.

CPCS

Certified Provider Credentialing Specialist — a NAMSS certification for credentialing professionals.

PSV

Primary Source Verification — confirming a provider’s credentials directly with the issuing source, as required by NCQA and URAC standards.

CPMSM

Certified Professional in Medical Services Management — a senior-level NAMSS certification.

TRICARE

The U.S. Department of Defense health program for service members, retirees, and their families.

FCVS

Federation Credentials Verification Service — managed by the Federation of State Medical Boards, used for multi-state licensure.

URAC

A healthcare accreditation body with credentialing-specific accreditation standards (program name; no longer spelled out as an acronym).

VA

U.S. Department of Veterans Affairs — the federal department serving veterans.

Find Your Specialty. Find Your People.

Mendry does not employ, place, refer, or supervise Direct Care Support Professionals. We list independent members so the two-hat practices that need them can find them. Your business, your reputation, your decisions.