Manager Credentialing

Topeka, Kansas

Instant Apply

5 days ago

Job Description

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

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 SummaryUnder 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 LocationThis 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 yearsBBTECH

Numbers & Facts

Location

Topeka, Kansas

Skills

Accreditation Standardsunmatched
Auditingunmatched
Business Administrationunmatched
Business Strategyunmatched
Business Supportunmatched
Coachingunmatched
Content Management Systems (CMS)unmatched
Continuous Improvementunmatched
Contract Requirementsunmatched
Corporate Policiesunmatched
Corrective Actionunmatched
Data Qualityunmatched
Dental Insuranceunmatched
Federal Laws and Regulationsunmatched
Fitnessunmatched
Healthcareunmatched
Healthcare Administrationunmatched
High School Diplomaunmatched
Incentive Programsunmatched
Leadershipunmatched
Maintain Complianceunmatched
National Committee for Quality Assurance (NCQA)unmatched
Network Administration/Managementunmatched
Network Supportunmatched
Operational Strategyunmatched
Operations Managementunmatched
Performance Managementunmatched
Performance Metricsunmatched
Primary Careunmatched
Process Improvementunmatched
Program Controlunmatched
Provider Credentialingunmatched
Quality Assuranceunmatched
Regulationsunmatched
Regulatory Requirementsunmatched
Resource Managementunmatched
Risk Managementunmatched
Set Goalsunmatched
State Laws and Regulationsunmatched
Succession Planningunmatched
Team Lead/Managerunmatched
Team Playerunmatched
Time Managementunmatched
Training Programunmatched
Training/Teachingunmatched
Utilization Review Accreditation Commission (URAC)unmatched
Vision Planunmatched
Work From Homeunmatched

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