Credential Specialist-State of Nevada

Company Description

Macro Outsourcing is a Business Process Outsourcing company that provides transcription, billing, and document management services to medical clinics and physicians in the United States. Our mission is to enhance the efficiency and manageability of back-office operations like medical transcription and billing, maintaining high quality and security standards as required by the healthcare sector and HIPAA regulations. Our team includes finance, technical, medical, and legal professionals with significant industry expertise. Macro focuses on customer satisfaction, excellence in service, and innovation to add value to our users.

Role Description (Credentialing Specialist – State of Nevada)

Position:

Location:

Overview:

The Credentialing Specialist will manage credentialing, recredentialing, provider enrollment, and privileging workflows for healthcare providers associated with Nevada-based health systems. The role requires strong documentation accuracy, regulatory understanding, and effective communication with providers, payers, and internal departments.

Responsibilities:

• Process and maintain initial credentialing and recredentialing files in compliance with

  Nevada state regulations

  , NCQA, CMS, and organizational policies.
• Verify provider qualifications including licensure (NV Board of Medical Examiners/Nursing Board), education, training, board certifications, work history, and malpractice coverage.
• Prepare and submit applications to commercial insurance plans, Medicare, Medicaid (Nevada Medicaid/Nevada Check Up), and other payers.
• Track expiring documents and ensure timely updates for licenses, DEA registrations, malpractice insurance, and other required credentials.
• Maintain accurate, confidential provider records within credentialing software systems.
• Communicate with providers, practice managers, payers, and internal departments to resolve credentialing issues or requests for information.
• Support the privileging process for Nevada-based hospitals and facilities, ensuring required documentation is complete and compliant.
• Assist with internal and external audits and quality reviews.
• Keep current with Nevada-specific regulatory changes affecting credentialing and provider enrollment.

Qualifications

Required:

• High school diploma or equivalent (Associate’s or Bachelor’s preferred).
• Experience in credentialing or provider enrollment, preferably in Nevada.
• Strong knowledge of CMS, NCQA, Medicare/Medicaid, and commercial payer requirements.
• Experience with credentialing platforms such as CAQH, ProviderSource, Echo, etc.
• Excellent attention to detail and strong organizational abilities.
• Effective verbal and written communication skills.
• Ability to manage multiple provider files and meet strict deadlines.

Preferred:

• CPCS (Certified Provider Credentialing Specialist) or CPMSM certification.
• Experience with Nevada Medicaid systems, Nevada Board portals, and major Nevada health networks.
• Familiarity with hospital privileging requirements and medical staff bylaws.