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Manager Credentialing

3 months ago

Topeka, Kansas, United States Blue Cross and Blue Shield of Kansas Full time

Credentialing Manager Position at a Leading Company in Kansas

Under the supervision of the provider relations director, the Credentialing Manager is in charge of managing credentialing procedures based on state, federal and URAC standards. The Manager will develop and implement a comprehensive strategy to ensure compliance with regulations, certifications, and efficiency, while overseeing workforce qualifications. This role seeks a strong leader well-versed in credentialing processes and regulations, with a proven track record of achieving excellence. The position is accountable for meeting requirements set by URAC, CMS, NTQL/Mental Health Parity Audits, and managing contracted services through TriWest for TRICARE, Healthy Blue for Medicaid, and other provider entities under delegated credentialing agreements. Failure to meet these standards may result in penalties or termination of agreements.

Hybrid Work Options and Competitive Compensation

This role offers hybrid work possibilities (9 or more onsite days per month) as per the Telecommuting Policy. Candidates must be based in Kansas or Missouri or willing to relocate. Join a highly respected organization and make a significant impact by choosing to work for one of the most trusted companies in Kansas.

Why Join Us?

  • Lead and Inspire: Guide and mentor your team to reach their full potential and achieve success.
  • Family Comes First: Enjoy a total rewards package that prioritizes the value of family for all employees.
  • Trust: Be part of one of the most reliable companies in Kansas.
  • Stability: Benefit from 80 years of commitment, compassion, and community.
  • Inclusive Work Environment: Join a workplace that values and respects diversity and inclusion.
Compensation

$93,000

Exempt grade 17

What You'll Do
  • Meet all credentialing requirements for BCBSKS, URAC, TriWest, CMS, Healthy Blue, and delegated provider entities in professional and institutional networks.
  • Collaborate across departments to ensure timely processing of all necessary elements for provider assessments.
  • Coordinate with external agencies to verify essential credentials like licensing, malpractice history, and training.
  • Work with providers and legal entities to verify malpractice cases or license restrictions.
  • Manage the credentialing of 15,000+ providers, ensuring confidentiality and accuracy of records.
  • Ensure completeness and accuracy of credentialing files and pass external audits.
  • Oversee delegated credentialing arrangements with provider entities and provide training on credentialing criteria.
  • Stay informed on NQTL/Mental Health Parity and ensure compliance with all standards.
  • Develop a forward-thinking credentialing strategy aligned with organizational goals and regulatory requirements.
  • Implement efficient processes prioritizing accuracy and compliance in credentialing applications.
  • Collaborate with legal and compliance teams to address regulatory issues and changes.
  • Establish quality control measures for accurate credentialing data and documentation.
  • Conduct regular audits to identify and rectify discrepancies in credentialing records.
Qualifications
  • Minimum of 5 years of credentialing experience with progressive responsibilities.
Preferred Qualifications
  • Bachelor of Science in Nursing with current RN license preferred.
  • Certified Provider Credentialing Specialist Certification or ability to obtain within a year.
  • Proficiency in medical terminology is a plus.
Benefits & Perks
  • Base compensation is part of a competitive Total Rewards package including:
    • Incentive pay program (EPIP)
    • Health/Vision/Dental insurance
    • 6 weeks paid parental leave, fertility/adoption assistance, and caregiver leave
    • 5% 401(k) plan matching, tuition reimbursement, and health/fitness benefits
Posting Close Date
June 13, 2024
Pay Rate Type
Salary