Senior Director Credentialing & Contracting (Hybrid) - Faculty Practice Plan

Washington University in St. Louis; St. Louis (MO); On-site; USD 129,800 - 228,400; Full time

Benefits offered by this job

Up to 22 days of vacation

Competitive health insurance packages

Defined contribution (403(b)) Retirement Savings Plan

Job summary

Washington University in St. Louis is seeking a professional to provide operational leadership for WashU Medicine's delegated credentialing organization. This role includes managing the credentialing process and negotiating optimal terms for managed care contracts.

The ideal candidate will have a Bachelor’s degree and experience in credentialing management within a large healthcare practice. Excellent negotiation and communication skills are essential. Opportunities for professional development and comprehensive benefits are offered.

Qualifications

• Bachelor's degree required.
• 5 years of experience in Credentialing Management and Managed Care Contracting is preferred.
• Strong negotiation, analytical and communication skills.

Responsibilities

• Manage delegated credentialing organization.
• Negotiate managed care contract language.
• Develop and implement policies for credentialing.

Skills

Analytical Thinking

Credentialing

Negotiation

Oral Communications

Written Communication

Database Applications

Education

Bachelor's degree

Master's degree or Ph.D.

Job description

Position Summary

Provides operational leadership for WashU Medicine's delegated credentialing organization, special contracting and negotiation of managed care contract language. Works jointly with the Senior Director of Managed Care Financial Contracting and Rate Analysis to secure optimal terms of participation with third‑party managed care organizations.

Scheduled Hours

40

Job Description

Primary Duties & Responsibilities

• Manages WashU Medicine's delegated credentialing organization.
• Manages WashU Physician’s Network (WUPN).
• Develops and implements policies and procedures pertaining to collection, and scope, of information required to carry out credentialing and re‑credentialing functions.
• Designs and manages a centralized practitioner database and the mechanism for direct or indirect access by staff and representatives of affiliated organizations. Assures an accurate, complete, and well‑documented information source.
• Maintains up‑to‑date knowledge of, and compliance with, credentialing standards established by NCQA, Joint Commission on the Accreditation of Healthcare Organization (JCAHO), URAC, any state or federal medical staff credentialing requirements and the delegation agreement of any applicable care plans.
• Advises administrative staff of affiliated physician organizations, hospitals, managed care plans and other third parties on issues pertaining to credentialing and re‑credentialing.
• Establishes and assures adherence to credentialing data confidentiality policy.
• Designs and conducts training and educational programs as required to assure credentialing compliance standards with hospital programs, delegated credentialing corporate representative, credentialing bodies and internal committees.
• Develops infrastructure to assure the accuracy and consistency of the interface with the National Practitioner Data Bank (NPDB), Federation of State Medical Boards (FSMB) Medicare, Medicaid, medical schools, societies, and the Departments of Insurance or Health. Serves as authorized agent in reporting of adverse actions to any such organization.
• Designs and executes the pre‑application, application and reapplication process associated with credentialing and re‑credentialing. Provides direct oversight of site visit nurse responsible for assessment of physician’s office environment and medical records.
• Coordinates site audits by managed care plans, accrediting bodies and state or federal agencies.
• Leads medical school liaison for transplant contracting.
• Maintains operational oversight of WashU Medicine's single patient discount contracting service.
• Responsible for negotiation of managed care contract language and securing acceptable managed care language terms.
• Works jointly with the Senior Director of Managed Care Financial Contracting and Rate Analysis to secure optimal financial terms for all third‑party agreements.
• Along with the Senior Director of Special Contracting and Contract Language, serves as the primary faculty practice plan liaison with BJC managed care contracting.
• Performs other duties as assigned.

Working Conditions

• Normal office environment.
• Typically sitting at a desk or table.
• Office equipment.

Education

Required: Bachelor's degree.

Certifications / Professional Licenses

No specific certification/professional license is required.

Work Experience

No specific work experience is required.

Skills

Not applicable.

Driver's License

A driver's license is not required.

Preferred Qualifications

Master's degree, Ph.D. - Doctor of Philosophy.

Certifications / Professional Licenses

No additional certification/professional licenses unless stated elsewhere in the job posting.

Work Experience

Credentialing Management And Managed Care Contracting In A Large Faculty Practice, Private Practice, Large Healthcare Or Third‑Party Payor Organization (5 Years).

Skills

Analytical Thinking, Business, Conceptualize Ideas, Credentialing, Credential Management, Database Applications, External Partners, Finance, Interpersonal Interactions, Negotiation, Oral Communications, Provider Credentialing, Relational Database Management, Social Interaction, Spreadsheets, Word Processing Applications, Written Communication.

Grade

G18

Salary Range

$129,800.00 - $228,400.00 / Annually.

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.

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.