Manager Credentialing

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

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

Job Summary

Under the direction of the Director, Provider Network Solutions Operations, the Manager, Credentialing is responsible for leading BCBSKS credentialing and recredentialing operations, accreditation compliance, delegated credentialing oversight, provider enrollment readiness, and quality assurance activities for professional and institutional provider networks. This position provides strategic and operational leadership to ensure compliance with NCQA, URAC, CMS, state and federal regulations, and delegated contractual requirements while promoting provider experience, operational excellence, and member access to care. The Manager establishes department goals, develops staff, drives continuous improvement, oversees audit and compliance performance, and collaborates across the enterprise to ensure accurate, timely, and compliant credentialing outcomes that support BCBSKS business objectives and regulatory obligations.

Work Location

This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

What you'll do

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.

Education

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

Experience

Minimum 5 years' experience in the healthcare industry with direct credentialing responsibility required Minimum 3 years' experience in a leadership, supervisory, or management role required Demonstrated experience leading teams, managing performance, and implementing operational improvements required Previous experience working with accreditation standards, regulatory compliance programs, and audit requirements required Previous experience with delegated credentialing oversight programs preferred

Travel

Minimal travel (0-10%) Travel may be required to support initiatives and / or represent BCBSKS credentialing program or services.

Knowledge, Skills and Abilities

Knowledge of provider network operations, managed care, provider contracting, and enrollment functions. Demonstrated leadership ability to build, coach, mentor, and develop high-performing teams while creating a culture of accountability, engagement, and continuous improvement. Strong knowledge of NCQA, URAC, CMS, state and federal regulatory requirements, accreditation standards, and delegated credentialing oversight requirements. Advanced decision-making, critical thinking, and problem-solving skills with the ability to assess risk and manage complex operational or compliance issues. Ability to lead operational excellence initiatives through process improvement, workflow optimization, quality management, and technology adoption. Strong collaboration and relationship-building skills with the ability to influence outcomes and build consensus across departments and stakeholder groups. Excellent verbal, written, and presentation communication skills with the ability to translate complex regulatory and operational information to diverse audiences. Ability to establish performance expectations, leverage metrics, and utilize data-driven decision-making to achieve business and compliance objectives. Strong organizational, project management, and prioritization skills with the ability to manage multiple initiatives and regulatory deadlines simultaneously. Commitment to integrity, accountability, professional development, and fostering an environment that supports learning, innovation, and organizational success.

Compensation

$101,520 - $126,900 annually Exempt Grade 17 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment. For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs. Our mission: Being the insurer Kansans trust with their health.