Remote New

Credentialing Consultant

Blue Cross and Blue Shield of Kansas City
parental leave, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States, Missouri, Kansas City
1400 Baltimore Avenue (Show on map)
Nov 21, 2025
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: Credentialing consultants ensure healthcare professionals meet necessary qualifications to provide care to our members. Their primary responsibilities include verifying and assessing provider education, background checks, employment history, licenses, certifications, insurance, and competencies through credentialing and recredentialing applications. They guarantee compliance with industry standards established by regulatory bodies, the Blue Cross and Blue Shield Association, and Quality Accreditation programs. This role collaborates with internal and external representatives to maintain complete and accurate documentation, manages credentialing software, monitors expiration dates for licenses and certifications, and assists with provider and executive escalations. The consultant supports understanding of Blue KC's credentialing policies and procedures across the organization. Job Description Verifies provider credentials and maintains up-to-date provider information in credentialing platforms such as CAQH and Cactus, including directories and operational data. Monitors expiration dates for licenses and certifications, ensuring all documentation is current and compliant. Coordinates all internal committee functions for presenting and reviewing provider credentials during initial credentialing and recredentialing processes. Coordinates provider communications following credentialing decisions, ensuring clear and timely updates. Serves as a subject matter expert on all credentialing and provider directory processes, offering guidance and support on compliance requirements. Directs delegated credentialing relationships to ensure oversight and adherence to required accreditation standards. Develops and coordinates credentialing policies and procedures Conducts semi-annual and annual delegation oversight audits that support accreditation requirements, including audits of NCQA and Non-NCQA certified delegates. Develops and presents presentations for Network and Member Experience Committee for NCQA CR reporting for Quality Accreditation. Responds to provider inquiries and implements evolving credentialing requirements timely Facilitate communications and meetings to resolve complex issues. Strong attention to detail, ensuring all provider data is accurate and up to date. Excellent communication abilities, both verbal and written, for effective interaction with providers and internal teams. Analytical thinking for assessing provider qualifications and resolving compliance issues. Ability to manage multiple priorities and deadlines in a fast-paced environment. Collaborative mindset for working with cross-functional teams and external partners. Minimum Qualifications Bachelor's Degree or an equivalent combination of education and experience 2-4 years of provider credentialing and quality accreditation for a payer organization Experience with provider management or credentialing software Proficiency with Microsoft Office software Preferred Qualifications Report Editing/Writing Experience 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.