Under the direction of the director of provider relations, the credentialing manager is responsible for managing credentialing initiatives according to state, federal and URAC standards. Manager, Credentialing will be responsible for developing and executing a comprehensive credentialing strategy that ensures regulatory compliance, qualifications, certifications, and efficiency of credentialing requirements are met by workforce to maintain regulatory compliance. This role requires a strong leader with a deep understanding of credentialing processes, regulatory standards, and a track record of driving excellence. This position is directly accountable for meeting all requirements by URAC, CMS, NTQL/Mental Health Parity Audits and delegated contracted services by TriWest for TRICARE, Healthy Blue for Medicaid, and all delegated oversight for specific provider entities who have entered into a delegated credentialing agreement. Failure to meet all expectations may result in penalties and/or risk of continuing an agreement for such program(s).
** This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Trust: Work for one of the most trusted companies in Kansas
• Stability: 80 years of commitment, compassion and community
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary 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 salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

• Meet all credentialing requirements for BCBSKS, URAC, TriWest, CMS, Healthy Blue, and delegated credentialing provider entities for all professional and institutional provider networks.
• Collaborate with other departments/units to ensure timely workflow of all required elements to determine the outcome of a provider.
• Work directly with external agencies to primary source verify all required licensing, malpractice, litigation, school and training, and other essential elements.
• Work directly with providers, licensing agencies, and attorneys to verify and discuss malpractice cases and/or license restrictions.
• Work directly with BCBSKS CMO, medical directors, and the corporate credentials committee to inform and resolve any provider issues involving a provider being credentialed or recredentialed.
• Effectively manages the credentialing or recredentialing of over 15,000 providers and must keep confidential records on each.
• Accountable for the completeness and accuracy of all credentialing files and must pass external audits.
• Accountable for the oversight and performance of all delegated credentialing arrangements with provider entities.
• Provide training to providers for the credentialing criteria and process.
• Must know all aspects of NQTL/Mental Health Parity and meet all requirements.
• Develop a clear and forward-thinking credentialing strategy aligned with organizational goals, industry best practices, and regulatory requirements.
• Design and implement streamlined and efficient credentialing processes that prioritize accuracy, compliance, and timely completion of applications.
• Collaborate with legal and compliance teams to address any regulatory changes or issues.
• Establish robust quality control measures to ensure the accuracy and completeness of employee credentialing data and documentation.
• Conduct regular audits and assessments to identify and rectify discrepancies or deficiencies in credentialing records.

• Minimum of 5 years of experience in credentialing with a track record of progressively responsible roles.

• Bachelor of Science in Nursing with current state license as a registered nurse preferred.
• Certified Provider Credentialing Specialist Certification, or able to obtain within one year.
• Proficiency in medical terminology preferred.

• 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
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

June 13, 2024Salary