Director Provider Credentialing and

JOB REQUIREMENTS: Description Role Snapshot The Director, Provider Credentialing & Data Governance oversees three highly interdependent pillars: Commercial credentialing/re-credentialing programs, a matrixed delegated credentialing audit framework, and maintainingpublic-facing provider directory integrity. This role is accountable to architect the transition and maintenance oflegacy data structures into a next-generation provider data platform. The Director directly impacts the Health Plan's financial accuracy, market expansions, and regulatory compliance by ensuring seamless provider data flowfrom initial onboarding through claims adjudication. Salary Range 140-160k, pay may flucuate based on experience. Hybrid Work Location This position will be hybrid, having the regional availability to come into our office 2 days a week. Our office location: WPS Corporate Center Building - 1717 W. Broadway in Madison, WI, 53713 How do I know this opportunity is right for me? If you enjoy the following: 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... For full info follow application link. Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/E4AA109B79A94967 Qualified females, minorities, and special disabled veterans and other veterans are encouraged to apply.