Manager Credentialing

Bcbsks

United States

Hybrid

USD 85,000 - 110,000

Full time

2 days ago

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Benefits offered by this job

Health insurance

6 weeks paid parental leave for new/bi

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness discounts

Job summary

BCBSKS is seeking a Manager, Credentialing to lead credentialing operations for professional and institutional networks, ensuring timely, accurate, and compliant outcomes. You will guide NCQA/URAC/CMS compliance and oversee audits while promoting provider experience and operational excellence.

The role requires 5+ years in healthcare credentialing and 3+ years in a leadership capacity, with strong collaboration across the enterprise and regulatory obligations.

Qualifications

Minimum 5 years' experience in healthcare with direct credentialing responsibility.
Minimum 3 years in a leadership, supervisory, or management role.
Experience with accreditation standards, regulatory compliance programs, and audit requirements.

Responsibilities

Lead credentialing and recredentialing operations for professional and institutional networks.
Establish and execute credentialing strategy, goals, and metrics.
Ensure compliance with NCQA, URAC, CMS, state and federal regulations.
Direct oversight of delegated credentialing arrangements and audits.
Develop and coach team, manage performance and succession planning.
Establish quality assurance programs and internal controls for data integrity.

Skills

Credentialing leadership

Regulatory compliance

Team development

Process optimization

Education

High school diploma or equivalent

Bachelor's degree in healthcare administration, business administration, human relations, or related field

In lieu of degree, 3 years relevant experience

Job description

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.

What you'll need

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

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