Director, Provider Data Governance & Credentialing

Socket.dev; Madison (WI); Hybrid; USD 140,000 - 160,000; Full time

Benefits offered by this job

Hybrid work options

Performance bonus

401(k) match

Health benefits start DAY 1

Professional development

Job summary

WPS, a health solutions company, seeks a Director of Provider Credentialing & Data Governance to oversee credentialing programs, a data governance framework, and a provider directory strategy. You will lead cross-functional teams to transition legacy data into a next-generation platform and ensure regulatory compliance across digital and print channels.

The role oversees audits, vendor management, and performance metrics, with hybrid work options and opportunities for leadership development.

Qualifications

• Bachelor’s degree in healthcare administration, business management or related field.
• 10+ years of health plan work experience with 5+ years in leadership in provider relations, network development functions and/or credentialing.
• Deep understanding of relevant healthcare federal and state regulations.
• Strong leadership and team-building capabilities.
• Excellent interpersonal and communication skills with the ability to influence and build relationships across various stakeholders.
• Strong critical thinking and analytical skills.
• Demonstrated experience identifying, prioritizing and driving work efforts with the highest returns on investment to achieve desired health plan goals.
• Ability to work in a complex, rapidly evolving and 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, develop mitigation plans, and communicate status to senior leadership.
• Establish and maintain performance standards and quality measures that support ongoing provider directory accuracy and ensure provider directories meet all state and federal regulatory requirements across digital and print channels.
• 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, steering agenda design, high-risk case escalations, and Peer Review workflows.
• Maintain credentialing data integrity and reporting, monitor key performance metrics and turnaround times.
• Manages vendors relationships that assist with key business processes and workflows.
• Evaluate and implement vendor technologies to improve data, directory accuracy, and/or network adequacy monitoring. Oversees system upgrades, enhancements, and ongoing software updates.
• Lead, mentor, and develop staff to foster a culture of accountability, excellence, and engagement.
• Support division training to ensure consistent application of policies, guidelines, and regulatory requirements.
• Other job-related duties may be assigned as assigned.

Skills

Leadership

Communication

Critical thinking

Analytical skills

Stakeholder management

Project prioritization

Education

Bachelor's degree in healthcare administration or related field

Job description

WPS, a health solutions company, seeks a Director of Provider Credentialing & Data Governance to oversee credentialing programs, a data governance framework, and a provider directory strategy. You will lead cross-functional teams to transition legacy data into a next-generation platform and ensure regulatory compliance across digital and print channels.

The role oversees audits, vendor management, and performance metrics, with hybrid work options and opportunities for leadership development.