Medical Credentialing Specialist

Medical Credentialing Specialist New Horizon Medical Solutions Las Vegas, NV Job Details Full-time $25 - $30 an hour 1 day ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Optimizing workflow processes Customer communication Document review (document control) Provider database maintenance for medical credentialing Provider enrollment for medical credentialing CMS Regulatory compliance Filing Mid-level 3 years CMS regulatory compliance Records management Continuous improvement Task prioritization Organizational skills Healthcare provider information Productivity software Document management systems Process management Communication skills Technical Proficiency Time management Full Job Description Job Overview 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. Key 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.

Qualifications Experience & Expertise:

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 (experience with MedTrainer preferred).

Technical Proficiency:

skilled in Microsoft Office and document management systems; adept at managing complex credentialing documentation and processes.

Communication & Professionalism:

excellent written and verbal communication skills; consistently maintain professional and polished interactions with clients, providers, and management teams across all lines of business.

Organizational Skills:

strong time management and organizational abilities; capable of managing multiple applications, deadlines, and priorities in a fast-paced environment.

Process Improvement & Results:

demonstrated ability to drive results, streamline processes, and enhance efficiency consistently.

Collaboration & Teamwork:

collaborative mindset, committed to supporting internal teams and external clients while fostering a productive and professional work environment. Benefits Company benefits; Medical Insurance (health, vision, dental), Paid Time Off (PTO), 401K. Consistent weekday work schedule. Opportunities for professional development and collaboration with a growing medical billing organization in a supportive team environment.