Credentialling Audit Specialist - US Medical Billing

Meds Nexus is seeking a detail-oriented Credentialing Audit Specialist to join our revenue cycle operations team. This role involves reviewing and auditing provider enrollment files, medical licenses, and insurance network documentation to ensure full compliance and minimize claim rejections for our U.S. healthcare clients. The position requires working the night shift from 5:30 PM to 2:30 AM, Monday through Friday, at our office located in Rawalpindi.

Key Responsibilities

- File & Data Auditing: Perform comprehensive audits of provider credentialing applications, CAQH profiles, state licenses, DEA certificates, and malpractice insurance policies to verify accuracy and completeness.

- Directory & Database Reconciliation: Cross-verify provider information across internal systems, hospital rosters, and commercial payer portals to ensure correct NPI, Tax ID, and specialty mappings.

- Compliance & Expiry Tracking: Monitor credentialing cycles and track document expiration dates to avoid lapses in provider active status.

- Discrepancy Identification: Detect and report data inconsistencies, missing documentation, or credentialing delays that could impact claim processing or payment.

- Cross-Functional Collaboration: Work closely with billing, accounts receivable, and payer relations teams to address credentialing-related claim issues.

- Reporting: Maintain detailed audit logs and provide regular compliance and status updates to management using MS Excel.

Required Qualifications

- 2 to 4 years of experience in U.S. provider credentialing, medical credentialing auditing, or healthcare compliance operations.

- Strong knowledge of U.S. healthcare credentialing guidelines, including CAQH processes, Medicare/Medicaid enrollment rules, and commercial payer requirements.

- Excellent written and verbal communication skills in English for effective documentation and coordination.

- Bachelor’s degree in Business Administration, Healthcare Management, or a related field.

Additional Information

This is an in-person role based at our Rawalpindi office. Candidates should be able to commute easily to the location. The position requires working night shifts from 5:30 PM to 2:30 AM, Monday through Friday. Applicants will be asked about their current and expected salary, notice period, experience level, and willingness to work night shifts during the application process.

Meds Nexus offers an opportunity to contribute to a critical function within healthcare revenue cycle management, ensuring compliance and smooth claim processing for U.S. medical billing. If you have the relevant experience and are comfortable working night hours, we encourage you to apply.