Director of Provider Credentialing & Data Stewardship

WPS Health Solutions

Monona (WI)

Hybrid

USD 140,000 - 160,000

Full time

5 days ago

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Benefits offered by this job

Hybrid work options

Performance bonus

401(k) match

Paid time off

Healthcare, dental, telehealth fromDAY

Leadership development programs

Additional benefits review

Job summary

WPS Health Solutions in Madison, Wisconsin seeks a Director of Provider Credentialing & Data Governance to oversee credentialing, data governance, and provider directory integrity while transitioning legacy data to a next-generation platform.

The role leads cross-functional teams, manages vendor relationships, and drives compliance with URAC/NCQA and CMS standards, influencing financial accuracy and market expansions. Hybrid work arrangement in Madison, WI.

Qualifications

Bachelor's degree or equivalent in a related field and leadership experience in provider relations/credentialing.
10+ years health plan experience with 5+ years in leadership roles in provider relations/credentialing.
Deep understanding of healthcare regulations at federal and state levels.
Strong leadership, communication, and stakeholder management capabilities.
Ability to drive high ROI initiatives in a complex, deadline-driven environment.
Experience implementing enterprise data governance and provider data principles.

Responsibilities

Establish enterprise standards and data governance to ensure a single source of provider information.
Define and manage processes supporting provider configuration, demographic maintenance, and complex contract setup within core systems.
Oversee vendor data management to maintain quality, compliance, and alignment with organizational goals.
Manage and evaluate vendor performance and coordinate with leaders to identify risks and mitigation plans.
Establish and maintain performance standards and quality measures for provider directories across digital and print channels.
Advance master data management practices and strengthen enterprise data governance related to provider information.
Manage credentialing and recredentialing arrangements, audits and corrective actions to maintain regulatory compliance.
Serve as Chair for the internal Credentialing Committee, steering agenda design and case workflows.
Maintain credentialing data integrity and reporting, monitor KPIs and turnaround times.
Manage vendor relationships and evaluate vendor technologies to improve data quality and network monitoring.
Lead, mentor and develop staff; support division training and policy adherence.