Senior Credentialing & Compliance Leader

Bcbsks; United States; Hybrid; USD 85,000 - 110,000; Full time

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

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.