Managed Care Credentialing Auditor (Hybrid) - FPP Physicians Network
Washington University in St. Louis, Saint Louis, MO, United States
Position Summary
Conducts credentialing audits to ensure compliance with internal policies, state regulations, contractual requirements, and NCQA standards. Evaluates credentialing processes and internal controls to identify risks and opportunities for improvement. Develops and implements audit plans, prepares detailed reports, and tracks corrective actions to resolution. Provides guidance to credentialing staff on compliance and quality improvement, while maintaining accurate audit documentation. Serves as a subject matter expert on credentialing audit standards and acts as a liaison with managed care payors to support regulatory adherence and effective communication.
Scheduled Hours
40 hours per week
Primary Duties & Responsibilities
Conducts credentialing audits to ensure compliance with internal policies, state regulations, contractual requirements, and NCQA standards.
Acts as a liaison between WashU Managed Care Credentialing and its 40+ Managed Care Payors, fostering strong relationships and open communication channels.
Maintains accurate and organized records of audit findings, reports, and other relevant documentation.
Evaluates credentialing processes and internal controls to identify risks and opportunities for improvement.
Stays up-to-date with industry regulations and best practices to ensure audit processes are aligned with current standards.
Communicates audit results and recommendations in a clear and professional manner to the Manager of Managed Care Credentialing.
Provides guidance and support to credentialing staff on compliance and quality improvement initiatives.
Performs other duties as assigned.
Working Conditions
Normal office environment.
Typically sitting at desk or table; repetitive wrist, hand, or finger movement (PC typing).
Office equipment.
Education
Required: High school diploma or equivalent high school certification.
Preferred: Associate degree.
Certifications / Professional Licenses
No specific certification or professional license is required for this position.
Work Experience
Managing Credentialing Processes – 3 years.
Database – 2 years.
Skills
Analytical Thinking
Credentialing
Critical Thinking
Delegation Management
Detail-Oriented
Effective Written Communication
Internal Auditing
Interpersonal Relationships
Microsoft Excel
Microsoft Office
Multiple Project Management
Organizing
Problem Solving
Software Program Management
Teamwork
Verbal Communications
Working Independently
Driver's License
A driver's license is not required for this position.
Grade
G11
Salary Range
$53,100.00 – $90,600.00 per annum.
Benefits Statement
Personal benefits include up to 22 days of vacation, 10 recognized holidays, and sick time; competitive health insurance packages with priority appointments and lower copays/coinsurance; a free Metro transit U‑Pass for eligible employees; a defined contribution retirement savings plan with employee and university contributions starting at 7%.
Wellness benefits include wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, an employee assistance program, financial resources, and access to dietitians.
Family benefits include 4 weeks of caregiver leave to bond with your new child, caregiver resources, and coverage for tuition for yourself and your family (up to 100% for WashU and 40% elsewhere after seven years).
EEO Statement
Washington University in St. Louis is committed to equal employment opportunity. The University’s policy provides equal opportunity and access to all job titles without regard to race, ethnicity, color, national origin, citizenship, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.
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Conducts credentialing audits to ensure compliance with internal policies, state regulations, contractual requirements, and NCQA standards. Evaluates credentialing processes and internal controls to identify risks and opportunities for improvement. Develops and implements audit plans, prepares detailed reports, and tracks corrective actions to resolution. Provides guidance to credentialing staff on compliance and quality improvement, while maintaining accurate audit documentation. Serves as a subject matter expert on credentialing audit standards and acts as a liaison with managed care payors to support regulatory adherence and effective communication.
Scheduled Hours
40 hours per week
Primary Duties & Responsibilities
Conducts credentialing audits to ensure compliance with internal policies, state regulations, contractual requirements, and NCQA standards.
Acts as a liaison between WashU Managed Care Credentialing and its 40+ Managed Care Payors, fostering strong relationships and open communication channels.
Maintains accurate and organized records of audit findings, reports, and other relevant documentation.
Evaluates credentialing processes and internal controls to identify risks and opportunities for improvement.
Stays up-to-date with industry regulations and best practices to ensure audit processes are aligned with current standards.
Communicates audit results and recommendations in a clear and professional manner to the Manager of Managed Care Credentialing.
Provides guidance and support to credentialing staff on compliance and quality improvement initiatives.
Performs other duties as assigned.
Working Conditions
Normal office environment.
Typically sitting at desk or table; repetitive wrist, hand, or finger movement (PC typing).
Office equipment.
Education
Required: High school diploma or equivalent high school certification.
Preferred: Associate degree.
Certifications / Professional Licenses
No specific certification or professional license is required for this position.
Work Experience
Managing Credentialing Processes – 3 years.
Database – 2 years.
Skills
Analytical Thinking
Credentialing
Critical Thinking
Delegation Management
Detail-Oriented
Effective Written Communication
Internal Auditing
Interpersonal Relationships
Microsoft Excel
Microsoft Office
Multiple Project Management
Organizing
Problem Solving
Software Program Management
Teamwork
Verbal Communications
Working Independently
Driver's License
A driver's license is not required for this position.
Grade
G11
Salary Range
$53,100.00 – $90,600.00 per annum.
Benefits Statement
Personal benefits include up to 22 days of vacation, 10 recognized holidays, and sick time; competitive health insurance packages with priority appointments and lower copays/coinsurance; a free Metro transit U‑Pass for eligible employees; a defined contribution retirement savings plan with employee and university contributions starting at 7%.
Wellness benefits include wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, an employee assistance program, financial resources, and access to dietitians.
Family benefits include 4 weeks of caregiver leave to bond with your new child, caregiver resources, and coverage for tuition for yourself and your family (up to 100% for WashU and 40% elsewhere after seven years).
EEO Statement
Washington University in St. Louis is committed to equal employment opportunity. The University’s policy provides equal opportunity and access to all job titles without regard to race, ethnicity, color, national origin, citizenship, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.
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