Manager, Provider Credentialing FT/Days

Three Crosses Regional Hospital•Las Cruces, NM

13h

About The Position

The Provider Credentialing Manager is responsible for coordinating the day-to-day operations of provider credentialing, recredentialing, and privileging processes for physicians and allied health professionals. This role ensures accurate, timely, and compliant practitioner onboarding and maintenance in alignment with Medical Staff Bylaws, hospital policies, CMS Conditions of Participation, The Joint Commission standards, and applicable state regulations. The Provider Credentialing Manager supports Medical Staff leadership by facilitating credentialing activities, maintaining practitioner files, coordinating professional practice evaluation workflows (OPPE/FPPE), and providing operational support to the Medical Executive Committee (MEC), Credentials Committee, and Peer Review / Professional Practice Committee processes. This position serves as a key operational liaison between providers, Medical Staff leadership, Quality, and hospital administration. The Provider Credentialing Manager implements established credentialing policies and procedures, prepares documentation for audits and surveys, and maintains accurate credentialing records to support continuous regulatory readiness. Complex credentialing matters, practitioner performance concerns, and regulatory issues are elevated appropriately to organizational leadership. The incumbent performs all duties in accordance with the highest standards of ethical and professional conduct, acts in the best interest of Three Crosses Regional Hospital, and fully supports the organization’s mission, vision, and values.

Requirements

Working knowledge of medical staff credentialing, privileging processes, and healthcare regulatory requirements, including CMS Conditions of Participation and accreditation standards.
Ability to manage multiple priorities, meet deadlines, and maintain accuracy in a fast-paced healthcare environment.
Strong verbal and written communication skills, with the ability to effectively interact with providers, leadership, and interdisciplinary teams.
Demonstrated proficiency in reviewing, organizing, and maintaining detailed confidential documentation in compliance with HIPAA and applicable regulatory requirements.
Excellent organizational, analytical, and time-management skills, with strong attention to detail.
Ability to build professional relationships with providers and internal stakeholders while maintaining appropriate confidentiality and professionalism.
Problem-solving skills with the ability to identify issues, recommend solutions, and escalate concerns appropriately.
Proficiency in the use of credentialing software, document management systems, and Microsoft Office applications, with the ability to learn new systems as needed.
Associate degree in Nursing, Business Administration, Healthcare Administration, or related field.
Three (3) to five (5) years of experience in a hospital or healthcare environment, with demonstrated knowledge of medical staff credentialing, provider onboarding, or healthcare regulatory processes.
One (1) to two (2) years of experience in a supervisory or lead role within a healthcare setting.
None.

Nice To Haves

Experience supporting provider credentialing, medical staff services, or regulatory compliance functions.
Experience assisting with staff or provider orientation, education, or onboarding processes.
Familiarity with Medical Staff Bylaws, credentialing software platforms, and accreditation standards (CMS, The Joint Commission, or equivalent).
Certification through the National Association Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM).
Demonstrated training or coursework in healthcare credentialing, medical staff services, regulatory compliance, or healthcare administration.

Responsibilities

Oversees day-to-day credentialing, recredentialing, and privileging processes for all Medical Staff and Allied Health Professionals, ensuring timely completion of applications, background checks, primary source verifications, and appointment actions in accordance with Medical Staff Bylaws, Rules and Regulations, CMS Conditions of Participation, Joint Commission standards, and applicable state and federal regulations.
Reviews credentialing applications and supporting documentation for completeness and compliance; identifies discrepancies or gaps and coordinates resolution with providers and appropriate stakeholders.
Maintains accurate, organized, and confidential provider credentialing records within credentialing software and document management systems, or Medical Staff Office files as applicable. Generates reports and tracking tools to monitor credentialing status, reappointment timelines, expirable, and performance metrics.
Supports professional practice evaluation workflows (OPPE/FPPE) by coordinating data collection, documentation, and routing for committee review.
Conducts routine internal audits of provider files to ensure regulatory readiness and supports preparation for external surveys, inspections, and accreditation reviews.
Implements established credentialing policies and procedures and contributes to ongoing process improvement initiatives to enhance efficiency, accuracy, and regulatory compliance.
Coordinates provider onboarding activities, working collaboratively with Medical Staff leadership, department directors, Quality, IT, and Human Resources to support orientation and access requirements.
Serves as a primary operational point of contact for credentialing inquiries, provider onboarding, audit requests, and documentation needs.
Prepares credentialing materials and reports for Medical Executive Committee, Credentials Committee, Peer Review / Professional Practice Committee, and other meetings as requested.
Identifies potential credentialing risks or practitioner issues and elevates concerns appropriately to organizational leadership.
Maintains current knowledge of credentialing standards, regulatory requirements, and industry best practices to support continuous compliance.
Attends meetings as assigned.
Performs other duties as assigned.