Credentialing Manager

BlueCross BlueShield of South Carolina

Credentialing Manager overseeing all provider credentialing activities for commercial, Medicare and Medicaid business at BlueCross BlueShield. Responsible for process improvements and compliance with standards.

Posted 5/15/2026full-timeRemote • South Carolina • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Manages day-to-day operations of credentialing area to include delegated credentialing activities.
Develops/implements credentialing policies/procedures/evaluation tools.
Evaluates/monitors/ensures compliance with National Committee of Quality Assurance (NCQA) and other regulatory standards/external review bodies.
Conducts on-site audits and inspections of delegated entities/provider files.
Communicates with/responds to internal and external representatives regarding data, delegation agreements, facility credentialing, and sanction issues.
Works with other departments to address/resolve credentialing issues.
Promotes efficiency through planning, problem solving, and application of industry standards.
Maintains accurate/current/efficient databases.
Coordinates/manages all activities and follows-up for credentialing committee.
Presents physicians/practitioners/providers with quality issues to committee for review.
Selects/trains/develops/guides staff and ensures excellent customer service is given to employees/customers/management, etc.
Monitors department performance and productivity.
Performs quality control functions for work performed.
Makes recommendations on process improvements and identifies training needs for staff.

Requirements

What you’ll need

Bachelor's in a job-related field
5 years healthcare experience to include healthcare program management, provider network, contracting or credentialing, managed care, medical education training, or physician office management; 2 of the 5 years must have been in a supervisory role or equivalent military experience in grade E4 or above.
Knowledge/understanding of NCQA and JCAHO credentialing standards, credentialing/recredentialing process for healthcare practitioners and ancillary/institutional providers.
Knowledge of medical terminology.
Ability to work independently, prioritize effectively, make sound decisions.
Good judgment skills.
Demonstrated customer service, organizational, and presentation skills.
Demonstrated verbal and written communication skills.
Analytical or critical thinking skills.
Ability to direct, motivate, and assess performance of others.

Benefits

Comp & perks

Subsidized health plans
Dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

credentialing policiescredentialing procedurescompliance evaluationon-site auditsquality controlprocess improvementsdata managementmedical terminologyhealthcare program managementprovider network management

Soft Skills

problem solvingcustomer serviceorganizational skillspresentation skillsverbal communicationwritten communicationanalytical skillscritical thinkingindependent workdecision making

Certifications

Bachelor's degree