Managed Care Credentialing Auditor (Hybrid) - FPP Physicians Network

Washington University in St. Louis • St. Louis, MO

1d • Hybrid

About The Position

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.

Requirements

• High school diploma or equivalent high school certification.
• Managing Credentialing Processes (3 Years)
• No specific certification/professional license is required for this position.
• A driver's license is not required for this position.

Nice To Haves

• Associate degree
• Database (2 Years)
• 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

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.

Benefits

• Up to 22 days of vacation, 10 recognized holidays, and sick time.
• Competitive health insurance packages with priority appointments and lower copays/coinsurance.
• Free Metro transit U-Pass for eligible employees.
• Eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.
• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!
• 4 weeks of caregiver leave to bond with your new child.
• Family care resources are also available for your continued childcare needs.
• Adult care resources.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees