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Blue Cross and Blue Shield of Kansas City · 4 hours ago

Manager, Credentialing

United States

Full-time

Remote

Senior Level

5+ years exp

Blue Cross and Blue Shield of Kansas City is seeking a Credentialing Manager to provide strategic leadership and oversight for the credentialing department. The role involves developing and executing credentialing strategies, ensuring compliance with regulatory requirements, and managing vendor relationships.

Association

Comp. & Benefits

Responsibilities

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, representing 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

Qualification

Credentialing standards expertiseRegulatory requirements knowledgeVendor managementCredentialing software proficiencyProvider data managementAnalytical skillsLeadership skillsCommunication skillsOrganizational skills

Required

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

Master's degree in healthcare administration, business, or a related field

Certification in Credentialing (e.g., CPCS, CPMSM) from a recognized professional organization

Strong familiarity with provider network operations, contracting, and healthcare consulting

Benefits

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

Company

Blue Cross and Blue Shield of Kansas City

Blue Cross and Blue Shield of Kansas City (Blue KC) is an independent licensee of the Blue Cross Blue Shield Association and a not-for-profit health insurance provider serving more than one million members in 32 counties in greater Kansas City and northwest Missouri and Johnson and Wyandotte counties in Kansas.

Founded in 1982

Kansas City, Missouri, USA

1001-5000 employees