Director of Credentialing at Progyny in New York, NY

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 to empower healthier, supported journeys thr