Manager Credentialing

Blue Cross and Blue Shield of Kansas • Topeka, KS

4d

About The Position

The Manager, Credentialing leads BCBSKS credentialing and recredentialing operations for professional and institutional provider networks. Under the direction of the Director, Provider Network Solutions Operations, this role provides strategic and operational leadership for accreditation compliance, delegated credentialing oversight, provider enrollment readiness, and quality assurance. The manager ensures compliance with NCQA, URAC, CMS, state and federal regulations, and delegated contractual requirements while supporting provider experience, operational excellence, and member access to care.

The role establishes department goals, develops staff, drives continuous improvement, oversees audit and compliance performance, manages resources, and collaborates across the enterprise to deliver accurate, timely, and compliant credentialing outcomes. The position is eligible to be hybrid or onsite under the company's Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate. Minimal travel of 0–10% may be required.

Requirements

• High school diploma or equivalent required.
• At least 5 years of healthcare industry experience with direct credentialing responsibility.
• At least 3 years of experience in a leadership, supervisory, or management role.
• Demonstrated experience leading teams, managing performance, and implementing operational improvements.
• Experience working with accreditation standards, regulatory compliance programs, and audit requirements.
• Knowledge of provider network operations, managed care, provider contracting, and enrollment functions.
• Knowledge of NCQA, URAC, CMS, state and federal regulatory requirements, accreditation standards, and delegated credentialing oversight requirements.
• Ability to build, coach, mentor, and develop teams and foster accountability, engagement, and continuous improvement.
• Advanced decision-making, critical-thinking, and problem-solving skills, including assessing risk and managing complex operational or compliance issues.
• Ability to lead process improvement, workflow optimization, quality management, and technology adoption.
• Strong collaboration and relationship-building skills, including ability to influence outcomes and build consensus across departments and stakeholder groups.
• Excellent verbal, written, and presentation communication skills, including ability to explain complex regulatory and operational information to diverse audiences.
• Ability to establish performance expectations, use metrics, and apply data-driven decision-making to achieve business and compliance objectives.
• Strong organizational, project management, and prioritization skills, including managing multiple initiatives and regulatory deadlines.
• Commitment to integrity, accountability, professional development, learning, innovation, and organizational success.
• Applicants must reside in Kansas or Missouri or be willing to relocate.

Nice To Haves

• Bachelor's degree or equivalent in healthcare administration, business administration, human relations, or a related field.
• Previous experience with delegated credentialing oversight programs.

Responsibilities

• Lead credentialing and recredentialing operations for professional and institutional provider networks, ensuring timely, accurate, and compliant outcomes.
• Establish and execute 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.
• Oversee 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 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.
• Maintain accountability for departmental performance and resource management.

Benefits

• Incentive pay program (EPIP).
• Health, vision, and dental insurance.
• Six weeks of paid parental leave for new mothers and fathers.
• Fertility and adoption assistance.
• Two weeks of paid caregiver leave.
• 401(k) plan with matching up to 5%.
• Tuition reimbursement.
• Health and fitness benefits, discounts, and resources.
• Paid vacation and sick leave.
• Paid maternity and paternity leave available immediately upon hire.
• Ongoing training and development programs.
• Flexible work environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED