Medical Credentialing Specialist

New Horizon Medical Solutions • Las Vegas, NV

3d • $25 - $30

About The Position

New Horizon Billing Solutions is a dynamic medical billing and administration organization seeking a professional, dedicated, and detail-oriented Medical Credentialing Specialist to manage provider credentialing services to providers. Responsibilities include ensuring all medical provider clients are credentialed with insurance carriers, hospitals, and other healthcare entities, maintaining compliance with regulatory standards, and supporting the onboarding process for new providers. The ideal candidate is organized, deadline-driven, and knowledgeable in requirements and credentialing workflows.

Requirements

• 3+ years of experience in medical credentialing and provider enrollment, with in-depth knowledge of PECOS, CAQH, NPPES, payer enrollment, healthcare facility processes, and other credentialing systems.
• Skilled in Microsoft Office and document management systems; adept at managing complex credentialing documentation and processes.
• Excellent written and verbal communication skills; consistently maintain professional and polished interactions with clients, providers, and management teams across all lines of business.
• Strong time management and organizational abilities; capable of managing multiple applications, deadlines, and priorities in a fast-paced environment.
• Demonstrated ability to drive results, streamline processes, and enhance efficiency consistently.
• Collaborative mindset, committed to supporting internal teams and external clients while fostering a productive and professional work environment.

Nice To Haves

• Experience with MedTrainer preferred.

Responsibilities

• Oversee national credentialing services for healthcare providers, including physicians, nurse practitioners, and allied health professionals; coordinate proper onboarding and credentialing account setup for new providers, ensuring accurate and timely credentialing and recredentialing, maintain comprehensive and organized documentation of all credentialing files and records.
• Review and verify provider documentation for compliance with regulatory standards, including education, work history, licensure, and certifications.
• Prepare, submit, manage, and track credentialing and enrollment applications to ensure timely approval and completion.
• Maintain accurate provider credentialing records in PECOS, CAQH, NPPES, and payer portals, compliance with CMS and payer-specific requirements, monitoring credentialing document due dates and revalidation requirements for ongoing compliance.
• Consistent communication with providers, insurance companies, and healthcare entities to resolve credentialing issues and/or inquiries, update on credentialing status and any necessary follow-up actions, and assist with medical billing provider enrollment-related claim issues when necessary.

Benefits

• Medical Insurance (health, vision, dental)
• Paid Time Off (PTO)
• 401K
• Opportunities for professional development
• Collaboration with a growing medical billing organization in a supportive team environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed