Managed Care Credentialing Auditor (Hybrid) - FPP Physicians Network

Managed Care Credentialing Auditor (Hybrid) - FPP Physicians Network Washington University in St Louis - 3.9 St. Louis, MO Job Details Full-time $53,100 - $90,600 a year 1 day ago Benefits Commuter assistance Caregiver leave Employee assistance program 403(b) Qualifications Record keeping Compliance risk assessment Internal controls Microsoft Excel Managed care Audit report preparation Audit engagement planning Regulatory compliance Compliance audits & assessments Mid-level Databases High school diploma or GED Quality assurance audits NCQA standards Quality improvement Typing Productivity software Associate's degree Delegation Communication skills Full Job Description Scheduled Hours 40 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. Job Description 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: Job Location/Working Conditions Normal office environment. Physical Effort Typically sitting at desk or table. Repetitive wrist, hand, or finger movement (PC Typing). Equipment Office equipment. The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time. Required Qualifications Education: High school diploma or equivalent high school certification. Certifications /Professional Licenses : No specific certification/professional license is required for this position. Work Experience: Managing Credentialing Processes (3 Years) Skills: Not Applicable Driver's License: A driver's license is not required for this position. More About This Job WashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles. Preferred Qualifications Education: Associate degree Certifications /Professional Licenses : No additional certification/professional licenses unless stated elsewhere in the job posting. Work Experience: 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 Grade G11 Salary Range $53,100.00 - $90,600.00 / Annually The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget. Questions For frequently asked questions about the application process, please refer to our External Applicant FAQ. Accommodation If you are unable to use our online application system and would like an accommodation, please email or call the dedicated accommodation inquiry number at ... and leave a voicemail with the nature of your request. All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Pre-Employment Screening All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening. Benefits Statement Personal Up to 22 days of vacation, 10 recognized holidays, and sick time. Competitive health insurance packages with priority appointments and lower copays/coinsurance. Take advantage of our free Metro transit U-Pass for eligible employees. WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%. Wellness Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more! Family We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We've got you covered. WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us. For policies, detailed benefits, and eligibility, please visit: EEO Statement Washington University in St. Louis is committed to the principles and practices of equal employment opportunity. It is the University's policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, citizenship (where prohibited by federal law), age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.