Manager Credentialing

Blue Cross and Blue Shield of Kansas•Topeka, KS

6d•$101,520 - $126,900

About The Position

Under the direction of the Director, Provider Network Solutions Operations, the Manager, Credentialing leads BCBSKS credentialing and recredentialing operations, accreditation compliance, delegated credentialing oversight, provider enrollment readiness, and quality assurance activities for professional and institutional provider networks. The role 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. This position is eligible to work hybrid or onsite under the Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Minimal travel of 0–10% may be required.

Requirements

High school diploma or equivalent required.
Minimum 5 years' experience in the healthcare industry with direct credentialing responsibility.
Minimum 3 years' 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.
Strong knowledge of NCQA, URAC, CMS, state and federal regulatory requirements, accreditation standards, and delegated credentialing oversight requirements.
Demonstrated ability to build, coach, mentor, and develop high-performing teams and foster accountability, engagement, and continuous improvement.
Advanced decision-making, critical thinking, and problem-solving skills, including 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, including the ability to influence outcomes and build consensus across departments and stakeholder groups.
Excellent verbal, written, and presentation communication skills, including the ability to translate complex regulatory and operational information for diverse audiences.
Ability to establish performance expectations, leverage metrics, and use data-driven decision-making to achieve business and compliance objectives.
Strong organizational, project management, and prioritization skills, including 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.
Must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

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 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 and resource management.