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
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.
