Credentialing Manager

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Location: Hybrid (Remote + Frankfort, KY as necessary)

About KPCA:

The Kentucky Primary Care Association was founded in 1976 as a not-for-profit 501 (c) (3) corporation of community health centers, rural health clinics, primary care centers, and all other organizations and individuals concerned about access to health care services for the state’s underserved rural and urban populations.

KPCA is charged with promoting the mutual interests of our members, with a mission to promote access to comprehensive, community-oriented primary health care services for the underserved.

Association members are providers of primary care – first contact, broadly trained physicians, physician assistants, nurse practitioners, behavioral health providers, dental providers, pharmacists, and other professionals delivering whole-person health care.

We support the development of primary care services throughout the Commonwealth by working with federal, state, and local legislators, regulatory agencies, health policy organizations, foundations, and payers to build a stronger primary care system in Kentucky.

As the Credentialing Manager
, you will report to the Director, Network Administration
. The Credentialing Manager will lead the Credentialing Team with responsibilities that include but are not limited to: overseeing the full credentialing lifecycle for providers, including initial credentialing, recredentialing, and ongoing maintenance and ensuring compliance with NCQA standards and state, federal, and payer requirements. This role manages primary source verification and continuous monitoring for licensure, exclusions, sanctions, and adverse events, while maintaining complete, audit-ready files.

The Credentialing Manager also supports and presents to the Credentialing Committee, leads and trains credentialing staff, and drives process improvement through workflow optimization and technology enhancements. The KPCA will employ the Credentialing Manager as an at-will employee.

Essential duties and responsibilities include, but are not limited to:

• Manage initial credentialing, recredentialing, and maintenance of provider files for NCQA delegated credentialing with all KY MCOs.
• • Maintain deep knowledge of NCQA standards and state/federal regulations; ensure all delegated activity aligns with NCQA accreditation & certification requirements.
  • Oversee PSV processes: licensure, DEA, board certification, NPDB, OIG/SAM exclusion checks; maintain documentation within the NCQA-required timelines.
  • Conduct monthly monitoring for exclusions, license expiration, sanctions, malpractice claims, and adverse events, and report exceptions to the credentialing committee.
  • Ensure complete, well-organized credentialing files; prepare documentation and audit trails for NCQA and delegated-payer audits; support annual internal audits.
  • Prepare agenda, provider grids, adverse action documentation, and present data; attend monthly committee meetings to facilitate decisions.
• Supervise credentialing staff to provide training on NCQA standards, process updates, and maintain team competency.
• Streamline workflows, implement automation, develop audit and reporting tools, troubleshoot credentialing systems, and support continuous improvement.
• Detail-oriented and focused on quality.
• Analysis and problem solving.
• Work independently as well as within team with various backgrounds.
• Excellent interpersonal, communication, presentation, and project management skills.
• Understanding of NCQA standards and guidelines.
• Ability to manage resources, independently and collaboratively organize a work priority schedule that is responsive to the KPCA CIN organizational strategies.
• Well-developed communication skills to clearly articulate policy, to collect data on providers, and to provide objective interpretation of data to providers and internal staff.
• Other duties as necessary.

• Bachelor’s degree (or equivalent) in related field (preferred).
• At least 1 year’s experience in a credentialing environment preferred.
• Knowledge of credentialing policies and procedures, familiarity with URAC, NCQA, and/or JCAHO standards desired.
• Familiarity with state and…