Medical Sales Representative

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

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.

• 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.
• 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.

• 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.

• Maintain accurate, organized, and confidential credentialing records in credentialing software (e.g., Med Trainer 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.

• 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.

• NAMSS Certified Provider Credentialing Specialist (CPCS) — the industry‑standard credential — or CPMSM; or actively pursuing certification once eligible.
• Experience with credentialing platforms such as Med Trainer, Credential Stream, or Modio.
• Knowledge of NCQA credentialing standards and delegated credentialing arrangements.

• 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.

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…