Director of Credentialing

PROGYNY; United States; On-site; USD 130,000 - 145,000; Full time

Benefits offered by this job

Family benefits

Mental health support

Equity and bonus program

401(k) with company match

Onsite meals

Job summary

Progyny is seeking a Credentialing Leader to oversee direct and delegated credentialing, ensuring regulatory compliance and high standards for provider networks.

The role drives credentialing workflows, maintains the credentialing database, and develops tools and policies while hiring and supervising staff. You will partner with HR, compliance, and leadership to mitigate risks and improve processes.

Qualifications

• Leadership experience in a credentialing setting with team management.
• Familiarity with Joint Commission, NCQA, CMS rules and state/federal rules.
• Experience with delegated credentialing oversight and audits.
• Proficiency with credentialing software and reporting tools.
• Ability to create and govern policies, workflows and metrics.
• Discretion with confidential peer review information.
• Ability to meet deadlines for committee work.

Responsibilities

• Oversees direct and delegated credentialing processes.
• Ensures accreditation and regulatory compliance.
• Leads credentialing operations: database, workflows, reports, policies.
• Hires and supervises staff; coordinates with leaders.
• Supports compliance reviews, audits, and site reviews.
• Defines KPI/SLAs and drives ongoing improvement.
• Serves as escalation point for providers and HR/compliance.

Skills

People leadership

Regulatory knowledge

Credentialing oversight

Data quality discipline

Policy & workflow development

Change management

Meeting coordination

Education

Bachelor's degree preferred

CPMSM/CPCS required

Tools

Credentialing software/CVOs

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 processes

• Ensures accreditation and regulatory compliance

• Leads credentialing operations, including:

  • Maintenance of the credentialing database

  • improving credentialing workflows, files, reports, and systems

  • creating tools/policies for records and communication

  • hiring and supervising staff

• Supports 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 improvement

• Serves as escalation point and partner for providers, staff leadership, HR/recruiting, compliance/legal

• Owns committee governance: agendas, minutes, decision tracking, and follow-through on actions

• Identifies credentialing risks and trends (sanctions, expirables, complaints) and implements mitigation plans

• Manages vendors/CVOs as applicable (contracts, performance, issue resolution)

• Establishes data governance (data integrity, access controls, audit trails) and delivers routine reporting to leadership

• Coordinates provider lifecycle workflows

• Trains 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 requirements

• Experience with delegated credentialing oversight and audit readiness; corrective action planning as needed

• Proficiency with credentialing software/CVO platforms, databases, and reporting tools; strong data quality discipline

• Ability to develop and manage policies, workflows, and metrics; lead process improvement and change management

• Strong judgment, discretion, and ability to maintain confidentiality with sensitive peer review and credentialing information

• Availability to support committee meetings and deadlines

• 10+ years in medical staff services/credentialing

• Bachelor's degree preferred (or equivalent experience)

• CPCS or CPMSM required

Please 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 toempower 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 Group

• Menopause and midlife care

• Health, dental, vision and life insurance options for employees and family

• Free in-person, virtual and text-based mental health and wellness support

• Paid time off, including vacation, sick leave, personal days and summer flex time

• Company equity

• Bonus program

• 401(k) plan with company match

• Access to on-demand legal and financial advice

• Learning and development programs to help you grow professionally and a mentorship program

• Company social eventsto include annual volunteer day and donation matching

• Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

In 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 anEqual Opportunity and affirm… We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand 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].