Strategic AVP, Provider Credentialing & Enrollment Leadership

WVU Medicine; Morgantown (WV); On-site; USD 150,000 - 210,000; Full time

Job summary

West Virginia University Health System in Morgantown, WV is seeking an Assistant Vice President, Provider Enrollment & Credentialing to guide system-wide credentialing, privileging, and payer enrollment across multiple sites. This role ensures accurate, efficient processes protecting revenue and enabling timely claims submission.

The AVP will drive strategy, compliance with NCQA, CMS, Joint Commission, and state requirements, and lead a large, multi-site team.

Qualifications

• Bachelor’s degree in health care administration or related field; 7+ years in credentialing and enrollment.
• 12+ years progressive credentialing experience with 5–8 years in leadership.
• Strong knowledge of NCQA, CMS, Joint Commission standards and payer enrollment processes.
• Experience with CAQH, PECOS, NPPES, and credentialing software platforms.
• Proven ability to lead cross-functional teams and manage regulatory compliance.
• Experience with M&A integration and network changes is a plus.

Responsibilities

• Develop and execute system strategy for credentialing and payer enrollment aligned with growth.
• Oversee multi-site credentialing, privileging, FPPE/OPPE, and Focused reviews with Medical Staff leadership.
• Drive automation to improve turnaround time, data accuracy, and revenue protection.
• Maintain compliance with NCQA, Joint Commission, CMS, and state requirements; lead survey readiness.
• Manage delegated and non-delegated payer enrollment across Medicare, Medicaid, and commercial payers.
• Oversee CAQH attestation, NPI/PECOS maintenance, and roster management.
• Provide SME guidance to executives on enrollment risk, growth, and integration scenarios.
• Partner with Payer Relations, Revenue Cycle, Legal, and Finance to support clean-claim submission.
• Lead vendor relationships for credentialing software and external entities.
• Ensure PHO-related credentialing and enrollment standards and accuracy of provider directories.

Skills

Executive leadership

Payer enrollment

NCQA CMS standards

CAQH PECOS NPPES

Strategic planning

Regulatory compliance

Education

Bachelor’s degree in health care administration

Tools

CAQH

PECOS

NPPES

CredentialStream

Job description

West Virginia University Health System in Morgantown, WV is seeking an Assistant Vice President, Provider Enrollment & Credentialing to guide system-wide credentialing, privileging, and payer enrollment across multiple sites. This role ensures accurate, efficient processes protecting revenue and enabling timely claims submission.

The AVP will drive strategy, compliance with NCQA, CMS, Joint Commission, and state requirements, and lead a large, multi-site team.