Credentialing Audit Specialist

We are seeking a detail-oriented Credentialing Audit Specialist to join our team on a full-time basis at our Rawalpindi office. This role involves managing provider enrollment portfolios for U.S. healthcare partners, ensuring compliance with insurance network requirements, and facilitating the approval of applications. The specialist will play a crucial role in removing credentialing obstacles that impact client revenue, working primarily during night shifts from 5:30 PM to 2:30 AM, Monday through Friday.

Key Responsibilities
- Investigate and resolve credentialing rejections, application delays, and discrepancies within payer files.
- Maintain daily communication with U.S. insurance representatives to monitor pending provider applications and secure active enrollment status.
- Audit and verify provider demographic information across external payer portals, clearinghouses, and internal billing systems to ensure data consistency.
- Manage tracking logs for provider documentation renewals, including state licensure and board certifications, to maintain compliance.
- Collaborate with billing team leads to identify gaps in network enrollment and address billing holds related to credentialing issues.

Required Qualifications
- Bachelor’s degree in Healthcare Administration, Business, or a related field.
- 3 to 5 years of practical experience in U.S. physician credentialing and primary source verification.
- Strong knowledge of CAQH maintenance, NPI registries, PECOS, and commercial payer enrollment procedures.
- Excellent organizational skills with a high level of accuracy and attention to detail.
- Proficient in written and spoken English communication.
- Willingness to commit fully to the on-site night shift schedule (5:30 PM – 2:30 AM).

Preferred Qualifications and Benefits
- Fixed weekends off (Saturday and Sunday) to support work-life balance.
- Competitive salary package including annual loyalty awards, inflation allowances, performance bonuses, and periodic increments.
- Access to financial benefits such as loan facilities, advance salary options, and Employee Endowment Fund Program (EEFP).
- Additional perks include paid time off, leave encashment, and medical coverage options.
- Office amenities like free dinner and daily tea or green tea refreshments to enhance the work environment.

Candidates should be prepared to commute to our office located on Murree Road, Rawalpindi, and be comfortable working the specified night shift hours. During the application process, candidates will be asked about their current and expected salary, relevant experience, and notice period status. This role requires in-person attendance to ensure effective collaboration and operational efficiency.