~15d ago

AVP Provider Enrollment Credentialing

Peak Health Administrative Buildingexecutive

OtherAvp

2 views0 saves0 applied

Quick Summary

Key Responsibilities

The statements described here are intended to describe the general nature of work being performed by people assigned to this position.

Technical Tools

OtherAvp

About the Role

~2 min read

The Assistant Vice President (AVP), Provider Enrollment & Credentialing provides strategic and operational leadership for all provider credentialing, privileging, and payer enrollment functions across the health system. This role is accountable for building and sustaining a high-performing, compliant, and scalable infrastructure that ensures providers are credentialed, privileges, and enrolled with government and commercial payers accurately and efficiently to directly protect the organization’s ability to bill, collect, and recognize revenue for provider services.

The AVP leads a multi-site or system-level team responsible for primary source verification, medical staff credentialing and reappointment, delegated and non-delegated payer enrollment, CAQH and provider database integrity, and ongoing regulatory compliance with NCQA, CMS, Joint Commission, and state-specific requirements. This individual serves as the organization’s subject matter expert on credentialing and enrollment matters, advising senior executives, Medical Staff leadership, and Payer Relations & Contracting on the operational and compliance implications of growth, Mergers & Acquisitions (M & A), network changes, and payer relationships.

This is a highly visible leadership role with significant cross-functional reach, requiring close collaboration with Payer Relations & Contracting, Revenue Cycle, Physician Recruitment, Medical Staff Services, Compliance, Legal, and Finance. The AVP is expected to bring both strategic judgment and hands-on operational expertise to a function with direct, measurable revenue impact.

Requirements

~1 min read

1. Bachelor’s degree in health care administration or a related field of study or seven (7) years of relevant work experience.

1. Advanced degree in Healthcare Administration (MHA), Business Administration (MBA), or a related field of study preferred.

2. Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM) through NAMSS

1. Twelve (12+) years of progressive experience in provider credentialing, medical staff services, and/or payer enrollment, including at least five to eight (5-8) years in a leadership/management capacity.

2. Demonstrated experience with NCQA, CMS, and Joint Commission standards as they relate to credentialing.

3. Experience overseeing delegated and non-delegated payer enrollment processes at a payer, multi-facility or system level.

4. Demonstrated success leading through a Joint Commission or NCQA survey cycle.

5. Proven people-leadership experience, including managing directors, managers and building team capability.

6. Working knowledge of credentialing/enrollment platforms (e.g., CAQH, PECOS, NPPES, CredentialStream).

1. Experience at an academic medical center or large multi-hospital health system ($5B+ net revenue).

2. Experience supporting M & A integration, consent-to-assign analysis, or large-scale network consolidation from a credentialing/enrollment perspective.

3. Experience with Physician-Hospital Organization (PHO) governance, delegated credentialing agreements, and PHO-level payer enrollment Familiarity with revenue cycle metrics and the financial impact of enrollment turnaround time on clean-claim rate and days in A/R Experience implementing workflow automation within a credentialing/enrollment function.

Responsibilities

~1 min read

1. Executive presence and the ability to translate complex regulatory and operational detail into clear, decision-ready information for C-suite and Medical Staff leadership. Strong independent judgment in interpreting and applying NCQA, Joint Commission, URAC, CMS, and state regulatory requirements. High-level relationship management across physicians, payers, market/site leaders, and senior executives. Advanced organization and project management skills, with the ability to manage multiple concurrent priorities and competing deadlines across sites. Analytical aptitude to assess staffing models, productivity benchmarks, and turnaround-time data, and translate findings into action. Skilled at developing and coaching, with a track record of building succession depth on a team. Sound, practical approach to ambiguity and problem-solving in a highly regulated, fast-changing environment

United States of America (Exempt)

500 PHH Administration

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.