Hybrid Director: Provider Data Governance & Credentialing

WPS—A health solutions company; Madison (WI); Hybrid; USD 140,000 - 160,000; Full time

Benefits offered by this job

Hybrid work options

Performance bonus

401(k) matching

Health insurance

Professional development

Job summary

WPS—A health solutions company in Madison, WI seeks a Director of Provider Credentialing & Data Governance to oversee credentialing programs, a delegated audit framework, and provider directory integrity. You will architect legacy-to-modern data platforms and influence financial accuracy, market expansion, and regulatory compliance from onboarding through claims adjudication.

The role is hybrid, requiring in-office presence in Madison two days per week, with strong leadership responsibilities

Qualifications

• Bachelor's degree in healthcare administration, business management or related field.
• 10+ years of health plan experience with 5+ years in leadership roles in provider relations, network development or credentialing.
• Deep knowledge of relevant federal and state healthcare regulations.
• Strong leadership and team-building capabilities with stakeholder influence.

Responsibilities

• Establish enterprise standards and data governance for provider information.
• Define processes for provider configuration, demographics, and contract setup in core systems.
• Oversee vendor data management for quality, compliance and alignment with goals.
• Lead credentialing and recredentialing, audits and corrective actions to meet URAC/NCQA and CMS requirements.
• Chair internal Credentialing Committee and manage high-risk case escalations.

Skills

Leadership

Data governance

Credentialing

Vendor management

Regulatory compliance

Education

Bachelor's degree

Job description

WPS—A health solutions company in Madison, WI seeks a Director of Provider Credentialing & Data Governance to oversee credentialing programs, a delegated audit framework, and provider directory integrity. You will architect legacy-to-modern data platforms and influence financial accuracy, market expansion, and regulatory compliance from onboarding through claims adjudication.

The role is hybrid, requiring in-office presence in Madison two days per week, with strong leadership responsibilities