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