Posted Sep 25, 2026 25 views
Meds IT Nexus is seeking a Credentialing Audit Specialist to join our team in Rawalpindi. This role focuses on ensuring quality control, compliance audits, and accuracy in provider enrollment for our US-based healthcare clients. The primary goal is to prevent billing delays by thoroughly reviewing credentialing applications and payer enrollment processes.
Key Responsibilities
- Audit provider credentialing applications, re-credentialing files, and payer enrollment packages to ensure accuracy and compliance.
- Verify essential provider documents, including medical licenses, NPI records, DEA certificates, and board certifications.
- Review payer portal submissions and contract setups across Medicare, Medicaid, and commercial networks.
- Identify and resolve application errors, compliance risks, or process delays promptly to maintain workflow efficiency.
- Monitor credentialing timelines closely to prevent claim denials and ensure timely provider enrollment.
- Maintain detailed audit logs and prepare comprehensive weekly and monthly reports for management review.
- Ensure all credentialing files comply with CAQH, PECOS, state regulations, and HIPAA guidelines.
Required Qualifications
- 2 to 3+ years of experience in US Provider Credentialing, Payer Enrollment, or Quality Auditing within the healthcare industry.
- Practical knowledge and hands-on experience with CAQH, PECOS, NPPES, NPI registry, and US payer processes.
- Strong attention to detail and excellent problem-solving abilities.
- Proficiency in Microsoft Excel for data tracking and reporting.
- Effective written and verbal communication skills in English.
- Bachelor’s degree in Healthcare, Business, or a related field.
Additional Information
Candidates should be prepared to answer questions regarding their experience as a Credentialing Audit Specialist, current and expected salary, notice period requirements, and commuting feasibility to the Rawalpindi office located on Murree Road. The role requires working in-person with office hours from 5:30 PM to 2:30 AM, so candidates must be comfortable with this shift timing.
This position offers the opportunity to work closely with a dedicated team focused on maintaining high standards in provider credentialing and enrollment accuracy, contributing directly to the efficiency of healthcare billing processes.
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Job Details
Meds IT Nexus
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