Specialist, Medical Credentialing

If you're looking for a place to call home and grow, Three Crosses Regional Hospital is looking for you! We are looking for a Medical Credentialing Specialist that is committed to clinical excellence and building a patient-centered culture.

Three Crosses Regional Hospital is an advanced independent healthcare organization led by a local team of professionals dedicated to high quality patient care and being the first choice of patients and providers in the communities we serve.

We are dedicated to hiring team members that will adapt to our culture, pride themselves in professionalism, integrity, transparency, two-way communication, and ensuring the safety and well-being of our patients and staff.

Evaluates, analyzes, and coordinates all aspects of the credentialing and re-credentialing processes for practitioners practicing within Three Crosses Regional Hospital and clinical entities. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers.

 Responsibilities

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and government/insurance agency regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and TCRH criteria.
• Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Credentialing Manager for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations and to ensure deadlines are met.
• Facilitates all parts of the onboarding process. 
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Effectively documents and reports the status of each candidate during the hiring process to Credentialing Manager
• Serves as the main point of contact for providers and answers, in a timely manner, any questions about the onboarding process.
• Enters, updates, and maintains data from provider applications into credentialing database, focusing on accuracy, and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.
• Communicates clearly with providers, their liaisons, medical staff leadership and Administration as needed to provide timely responses upon request on day-to-day credentialing and privilege issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Attend staff meetings as needed.
• Other duties as assigned.

 Education and Experience

• Required: High School Diploma or GED
• Preferred: 2 years of related experience – will train the right candidate

 Three Crosses Regional Hospital is an equal opportunity employer.