Manager, Credentialing

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience.  Some of our offerings include:

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

• Annual incentive bonus plan based on company achievement of goals

• Time away from work including paid holidays, paid time off and volunteer time off

• Professional development courses, mentorship opportunities, and tuition reimbursement program

• Paid parental leave and adoption leave with adoption financial assistance

• Employee discount program

Job Description Summary:

Job Description

•    Direct and optimize the end-to-end credentialing and re-credentialing processes for all provider types, including physicians, advanced practice clinicians, ancillaries, and facilities, ensuring operational excellence and regulatory compliance.
•    Function as the organization’s subject matter expert in provider credentialing, rep-resenting Blue KC during regulatory surveys, audits, quality assurance reviews, payer credentialing processes, and industry forums
•    Develop and deliver executive-level reports and audits related to credentialing activities, accreditation requirements, and operational performance.
•    Establish and enforce credentialing standards, policies, and procedures in alignment with NCQA, CMS, state, and federal regulations, proactively adapting to changes in the regulatory landscape.
•    Oversee the management and integrity of provider credentialing databases and documentation systems, including sPayer, ensuring data accuracy, security, and accessibility.
•    Lead cross-departmental initiatives to resolve complex credentialing issues, accelerate provider onboarding, and enhance stakeholder satisfaction.
•    Design and implement robust monitoring systems to track credentialing timelines, application progress, and verification processes, ensuring timely completion and minimizing risk.
•    Spearhead the development and continuous improvement of credentialing workflows, leveraging technology and analytics to drive efficiency and quality.
•    Present credentialing files and recommendations to medical staff committees, governing boards, and insurance payers, serving as the organization’s credentialing expert.
•    Manage relationships with outsourced vendors, negotiating contracts, monitoring performance, and ensuring compliance with service level agreements (SLAs).
•    Provide visionary leadership to credentialing staff, fostering a culture of excellence, professional growth, and accountability through training, mentoring, and performance management; identify opportunities for staff education and process enhancement and improvement.
•    Evaluate departmental operations, recommend strategic improvements, and implement initiatives to advance organizational objectives and regulatory readiness.
•    Ensure meticulous recordkeeping and data confidentiality, upholding HIPAA and organizational policies.
 

Minimum Qualifications

•    Bachelor’s degree in healthcare administration, business, or a related field
•    Five or more years of progressive leadership experience in health plan credentialing or provider enrollment, with a proven record of managing complex, multi-specialty credentialing operations
•    Expertise in credentialing standards, regulatory requirements (e.g., NCQA, Joint Commission, CMS, state statutes), and accreditation processes
•    Exceptional strategic, analytical, organizational, and communication skills, with the ability to lead teams and manage multiple priorities in a dynamic environment
•    Prior success in credentialing program development, accreditation readiness, and vendor management
•    Experience with Symplr Payer and/or other credentialing applications
•    Advanced proficiency in credentialing software, provider data management systems, and Microsoft Office Suite
 

Preferred Qualifications

•    Master’s degree in healthcare administration, business, or a related field
•    Certification in Credentialing (e.g., CPCS, CPMSM) from a recognized profession-al organization
•    Strong familiarity with provider network operations, contracting, and healthcare consulting
 

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.