Director, Provider Credentialing & Data Governance - Hybrid

Wis Phys Svc Ins Corp; Madison (WI); Hybrid; USD 140,000 - 160,000; Full time

Benefits offered by this job

401(k) with match

Health insurance

Dental insurance

Telehealth services

Paid time off

Professional and LeadershipDevelopment

Job summary

WPS in Madison, Wisconsin invites an experienced Director to lead provider credentialing and data governance. You will oversee credentialing programs, audits, and the transition to a modern data platform, ensuring accurate provider data from onboarding through claims.

This role blends strategic leadership with regulatory compliance, vendor management and performance metrics. The position is hybrid with in-office presence required ~2 days per week at the Madison office.

Qualifications

• Bachelors degree in healthcare administration, business management or a related field, or equivalent combination of education and experience.
• Ten (10) or more years of health plan work experience with 5 or more years in leadership in provider relations, network development and/or credentialing.
• Deep understanding of healthcare federal and state regulations and requirements.
• Strong leadership and team-building capabilities.
• Excellent interpersonal and communication skills with the ability to influence and build relationships across stakeholders.
• Ability to work in a complex, deadline-driven environment with multiple internal and external stakeholders.

Responsibilities

• Establish enterprise standards and data governance to ensure a single, trusted 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 develop mitigation plans.
• Establish and maintain performance standards and quality measures that support ongoing provider directory accuracy and regulatory compliance.
• Advance master data management practices and strengthen enterprise data governance related to provider information.
• Manage credentialing and recredentialing arrangements, contractual obligations, audits and corrective actions to maintain compliance with URAC/NCQA, CMS and all regulatory requirements.
• Serve as Chair for the internal Credentialing Committee and oversee workflows.

Skills

Leadership

Communication

Critical thinking

Analytical skills

Education

Bachelors degree in healthcare administration

Job description

WPS in Madison, Wisconsin invites an experienced Director to lead provider credentialing and data governance. You will oversee credentialing programs, audits, and the transition to a modern data platform, ensuring accurate provider data from onboarding through claims.

This role blends strategic leadership with regulatory compliance, vendor management and performance metrics. The position is hybrid with in-office presence required ~2 days per week at the Madison office.