MEDICAL CREDENTIALING SPECIALIST

Socket.dev; Las Vegas (NV); On-site; USD 46,000 - 60,000; Full time

Benefits offered by this job

PTO

Medical

Dental

Vision

401(k)

Job summary

New Horizon Billing Solutions (NHBS) is seeking a Medical Credentialing Specialist to manage credentialing, re-credentialing, and payer enrollment for healthcare providers. You will verify licenses and certifications, maintain provider data in CAQH, NPPES, and PECOS, and track expirables to ensure uninterrupted billing.

Highlights include ensuring regulatory and payer compliance, documentation in credentialing software, and acting as a primary contact for providers on credentialing status.

Qualifications

• High school diploma or GED is required.
• 2+ years of credentialing and/or payer enrollment experience in healthcare.
• Experience with CAQH, NPPES, PECOS and payer enrollment processes.

Responsibilities

• Process initial credentialing and re-credentialing for physicians and providers.
• Perform primary source verification of education, training, licensure, and certifications.
• Maintain provider files in accordance with regulatory and payer requirements.
• Submit credentialing/enrollment packets to Medicare, Medicaid, and commercial payers.
• Generate reports on credentialing status and support audits.

Skills

Attention to detail

Communication skills

Multitasking

Discretion/Confidentiality

Education

High school diploma or GED

Associate’s or Bachelor’s degree

NAMSS CPCS or CPMSM (certification)

Tools

CAQH

NPPES

PECOS

MedTrainer

CredentialStream

Modio

Microsoft Office

Job description

POSITION INFORMATION

Company: New Horizon Billing Solutions (NHBS)

Department: Credentialing Department

Location: In-Office / On-Site – Las Vegas, NV

Schedule: Monday – Friday, 9:00 AM – 5:00 PM

Employment Type: Full-Time

Benefits: PTO, Medical, Dental, Vision, 401(k)

POSITION SUMMARY

The Medical Credentialing Specialist is responsible for managing and maintaining the credentialing, re-credentialing, and payer enrollment process for healthcare providers, ensuring compliance with all regulatory, accreditation, and payer requirements. This role verifies provider qualifications, licenses, and certifications in a timely and accurate manner, maintains provider data across industry platforms (CAQH, NPPES, PECOS), tracks expirables proactively, and serves as the primary point of contact for providers on credentialing status — safeguarding the organization’s and its clients’ ability to bill and deliver care without interruption.

KEY RESPONSIBILITIES

Credentialing & Re-Credentialing

• Process initial credentialing and re-credentialing applications for physicians, advanced practice providers, and other licensed professionals.
• Perform primary source verification of education, training, licensure, board certification, work history, malpractice history, and other credentials.
• Maintain up-to-date provider files and profiles in accordance with organizational, state, federal, and payer requirements.

Payer Enrollment

• Prepare and submit credentialing/enrollment packets to Medicare, Medicaid, and commercial payers; maintain follow-up until approval is confirmed.
• Create and maintain provider records in CAQH, NPPES, and PECOS; complete attestations and keep profiles current.
• Coordinate linkage of providers and TINs to payer portals to enable claims submission and prior authorization access.

Compliance & Quality Assurance

• Monitor and track license, certification, DEA, and insurance expiration dates; initiate renewals proactively.
• Ensure all providers meet compliance standards set by regulatory agencies and accrediting bodies (e.g., NCQA standards).
• Stay informed on changes to credentialing regulations and payer requirements.

Documentation & Reporting

• Maintain accurate, organized, and confidential credentialing records in credentialing software (e.g., MedTrainer or comparable platforms).
• Generate reports on credentialing status, expirables, and compliance metrics for leadership review.
• Serve as primary point of contact for providers regarding credentialing status; assist with audits and site visits as needed.

REQUIRED QUALIFICATIONS & EXPERIENCE

• High school diploma or GED required.
• 2+ years of credentialing and/or payer enrollment experience in a healthcare setting (multi-specialty or hospital preferred).
• Hands-on familiarity with CAQH, NPPES, PECOS, and payer enrollment processes for Medicare, Medicaid, and commercial plans.
• Proficiency in Microsoft Office Suite and credentialing software.

PREFERRED QUALIFICATIONS (INDUSTRY STANDARD)

• Associate’s or Bachelor’s degree.
• NAMSS Certified Provider Credentialing Specialist (CPCS) — the industry-standard credential — or CPMSM; or actively pursuing certification once eligible.
• Experience with credentialing platforms such as MedTrainer, CredentialStream, or Modio.
• Knowledge of NCQA credentialing standards and delegated credentialing arrangements.

SKILLS & COMPETENCIES

• Strong attention to detail and organizational skills; ability to manage high volumes of time-sensitive applications.
• Excellent written and verbal communication with providers, payers, and internal departments.
• Ability to manage multiple priorities and deadlines in a fast-paced environment.
• Discretion and confidentiality in handling sensitive provider and organizational information.

COMPENSATION

Estimated Salary Band: $46,000 – $60,000 per year (approx. $22.10 – $28.85/hour)

Estimated banding based on current Las Vegas, NV market data (Robert Half 2026 range $46,375–$60,420; ZipRecruiter average ~$50,300; Glassdoor average ~$57,000; September 2026). Final offer to be commensurate with experience and NAMSS certification.

WORK ENVIRONMENT & PHYSICAL REQUIREMENTS

• Professional office environment; prolonged periods of sitting at a desk and working on a computer.
• Fast-paced, deadline-driven setting requiring sustained attention to detail and strict confidentiality of protected health information (PHI) under HIPAA.

WHY JOIN NHBS

• Competitive pay and comprehensive benefits.
• Supportive, collaborative team environment.
• Opportunities for professional growth, continuing education, and advancement.

New Horizon Billing Solutions is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.