Managed Care Credentialing Auditor (Hybrid) - FPP Physicians Network

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 cont...