Director of Credentialing

Progyny, Inc; New York (NY); On-site; USD 130,000 - 145,000; Full time

Benefits offered by this job

Family friendly benefits

Paid time off

401(k) with company match

Mentorship program

Equity

Volunteer day

Donation matching

Onsite meals & snacks

Job summary

Progyny, Inc. in New York City seeks a Senior Credentialing Lead to oversee direct and delegated credentialing, ensuring regulatory compliance and data integrity across the provider network.

You will lead a team, optimize credentialing workflows, monitor KPIs, coordinate audits, and partner with compliance, legal, HR, and providers to drive continuous improvement.

Qualifications

• Proven people leadership experience (hiring, coaching, performance management).
• Working knowledge of standards bodies (Joint Commission, NCQA, CMS COPs) and state/federal requirements.
• Experience with delegated credentialing oversight and audit readiness; corrective action planning.
• Proficiency with credentialing software, databases, and reporting tools.
• Ability to develop and manage policies, workflows, and metrics; drive change.

Responsibilities

• Oversee direct and delegated credentialing processes.
• Ensure accreditation and regulatory compliance.
• Lead credentialing operations, maintaining databases and workflows.
• Develop tools and policies for records and communications.
• Coordinate provider lifecycle workflows and KPI monitoring.
• Train stakeholders and standardize workflows across entities.
• Identify credentialing risks and implement mitigation plans.
• Manage vendor/CVO relationships and audits.
• Provide routine reporting to leadership and serve as escalation point.

Skills

Leadership

Regulatory knowledge

Process improvement

Stakeholder management

Change management

Education

Bachelor's degree preferred

CPCS or CPMSM certification required

Tools

Credentialing software

CVO platforms

Databases

Reporting tools

Job description

Thank you for considering Progyny!At Progyny, we believe that every member deserves access to the highest quality fertility and family-building care, delivered with compassion, expertise, and trust. Behind every provider in our network is a rigorous credentialing process designed to ensure our members receive care from qualified professionals who meet the highest standards of clinical excellence and compliance. We take great pride in the strength and integrity of our provider network because we know that the quality of our providers directly impacts the experience and outcomes of the members we serve. The Credentialing team plays a critical role in upholding these standards, supporting our providers, and helping ensure that Progyny continues to deliver an exceptional care experience.What you’ll do…Provides oversight into direct and delegated credentialing processesEnsures accreditation and regulatory complianceLeads credentialing operations, including:Maintenance of the credentialing databaseimproving credentialing workflows, files, reports, and systemscreating tools/policies for records and communicationhiring and supervising staffSupports ongoing compliance through document review, delegated-entity audits, sanctions/complaints review, and site reviews.Defines and monitors credentialing KPIs/SLAs (turnaround time, quality audits, file completeness) and drives continuous improvementServes as escalation point and partner for providers, staff leadership, HR/recruiting, compliance/legalOwns committee governance: agendas, minutes, decision tracking, and follow-through on actionsIdentifies credentialing risks and trends (sanctions, expirables, complaints) and implements mitigation plansManages vendors/CVOs as applicable (contracts, performance, issue resolution)Establishes data governance (data integrity, access controls, audit trails) and delivers routine reporting to leadershipCoordinates provider lifecycle workflowsTrains stakeholders and standardizes criteria and workflows across entities (as applicable)About you…Proven people leadership (hiring, coaching, performance management)Working knowledge of key standards/bodies (e.g., The Joint Commission, NCQA, CMS Conditions of Participation) and applicable state/federal requirementsExperience with delegated credentialing oversight and audit readiness; corrective action planning as neededProficiency with credentialing software/CVO platforms, databases, and reporting tools; strong data quality disciplineAbility to develop and manage policies, workflows, and metrics; lead process improvement and change managementStrong judgment, discretion, and ability to maintain confidentiality with sensitive peer review and credentialing informationAvailability to support committee meetings and deadlines10+ years in medical staff services/credentialingBachelor’s degree preferred (or equivalent experience)CPCS or CPMSM requiredPlease note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.About Progyny:Progyny (Nasdaq: PGNY) is a global leader in women’s health and family building solutions, trusted by the nation’s leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians.Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.Our mission is to empower healthier, supported journeys through transformative fertility, family building and women’s health benefits.Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.Our perks:Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation GroupMenopause and midlife careHealth, dental, vision and life insurance options for employees and familyFree in-person, virtual and text-based mental health and wellness supportPaid time off, including vacation, sick leave, personal days and summer flex timeCompany equityBonus program401(k) plan with company matchAccess to on-demand legal and financial adviceLearning and development programs to help you grow professionally and a mentorship programCompany social events to include annual volunteer day and donation matchingFlex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY officeIn compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $130,000 - $145,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.Progyny is proud to be an Equal Opportunity and Affirmative Action employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law.If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to [e-mail].#LI-CB1