Credentialing Manager: NCQA Compliance & Team Leadership

Blue Cross & Blue Shield of Kansas, Inc.; Topeka (KS); Hybrid; USD 102,000 - 127,000; Full time

Benefits offered by this job

Health/Vision/Dental insurance

6 weeks paid parental leave

Tuition reimbursement

401(k) plan matching up to 5%

Fertility/Adoption assistance

2 weeks paid caregiver leave

Health & fitness benefits

Job summary

Blue Cross and Blue Shield of Kansas, Inc. seeks a Manager, Credentialing to lead credentialing and recredentialing operations for professional and institutional networks, ensuring timely, accurate, and compliant outcomes.

You will develop strategy, oversee audits, ensure regulatory compliance, and collaborate across the enterprise to support provider network objectives. Hybrid or onsite work; Kansas or Missouri residency preferred.

Qualifications

• Minimum 5 years' experience in the healthcare industry with direct credentialing responsibility.
• Minimum 3 years in a leadership, supervisory, or management role.
• Experience with accreditation standards (NCQA, URAC, CMS) and audit requirements.
• Experience with delegated credentialing oversight programs.

Responsibilities

• Lead credentialing and recredentialing for professional and institutional networks.
• Set credentialing strategy, goals, metrics, and priorities.
• Ensure compliance with NCQA, URAC, CMS, and state/federal regs.
• Oversee delegated credentialing arrangements; monitor and audit.

Skills

Provider network operations

Leadership

Regulatory compliance

Data-driven decision making

Communication skills

Project management

Education

Bachelor's degree in healthcare administration or related field

High school diploma or equivalent

Job description

Blue Cross and Blue Shield of Kansas, Inc. seeks a Manager, Credentialing to lead credentialing and recredentialing operations for professional and institutional networks, ensuring timely, accurate, and compliant outcomes.

You will develop strategy, oversee audits, ensure regulatory compliance, and collaborate across the enterprise to support provider network objectives. Hybrid or onsite work; Kansas or Missouri residency preferred.