Hybrid Credentialing Manager – Compliance & Strategy

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

Benefits offered by this job

Health insurance

Vision insurance

Dental insurance

Parental leave

Fertility/Adoption assistance

Caregiver leave

401(k) match

Tuition reimbursement

Wellness benefits

Job summary

Blue Cross and Blue Shield of Kansas is seeking a Manager, Credentialing to lead credentialing and recredentialing for professional and institutional networks. You will drive compliance with accrediting bodies and regulations while delivering timely, accurate outcomes.

You will oversee delegated credentialing programs, mentor staff, and partner with enterprise teams to align with regulatory requirements and business objectives.

Qualifications

• High school diploma or equivalent required.
• Bachelor’s degree in healthcare administration, business administration, human relations, or related field preferred.
• In lieu of degree, an additional 3 years of relevant experience required.

Responsibilities

• Lead all credentialing and recredentialing operations for professional and institutional provider networks, ensuring timely, accurate, and compliant outcomes.
• Establish and execute the credentialing strategy, goals, performance metrics, and priorities aligned with BCBSKS business objectives.
• Ensure compliance with NCQA, URAC, CMS, state and federal regulations, corporate policies, and accreditation standards.
• Direct oversight of delegated credentialing arrangements, including monitoring, auditing, and corrective action management.
• Lead, develop, and manage team performance through coaching, training, succession planning, accountability, and employee engagement.
• Establish quality assurance programs and internal controls to ensure credentialing data integrity, accuracy, and audit readiness.
• Serve as the credentialing subject matter expert and primary resource for providers, leadership, internal business partners, and external stakeholders.
• Partner with connected enterprise business areas to support provider network operations and regulatory requirements.
• Oversee Corporate Credentialing Committee readiness, provider case review processes, and reporting activities.
• Drive continuous improvement through process optimization, technology adoption, workflow redesign, and data-informed decision making.
• Monitor operational, compliance, accreditation, and provider network risks and implement mitigation strategies to protect organizational interests.
• Maintain accountability for departmental performance, resource management.

Skills

Leadership

Regulatory knowledge

Communication

Problem solving

Team development

Quality assurance

Education

High school diploma

Bachelor's degree preferred

Experience in lieu of degree

Job description

Blue Cross and Blue Shield of Kansas is seeking a Manager, Credentialing to lead credentialing and recredentialing for professional and institutional networks. You will drive compliance with accrediting bodies and regulations while delivering timely, accurate outcomes.

You will oversee delegated credentialing programs, mentor staff, and partner with enterprise teams to align with regulatory requirements and business objectives.