Director of Credentialing
About The Position
The Director of Credentialing plays a critical role in upholding Progyny's standards for its provider network. This role provides oversight into direct and delegated credentialing processes, ensuring accreditation and regulatory compliance. The position leads credentialing operations, including maintaining the credentialing database, improving workflows, files, reports, and systems, and creating tools/policies for records and communication. It also involves hiring and supervising staff, supporting ongoing compliance through document review, delegated-entity audits, sanctions/complaints review, and site reviews. The Director will define and monitor credentialing KPIs/SLAs, serve as an escalation point, own committee governance, identify credentialing risks, manage vendors/CVOs, establish data governance, and coordinate provider lifecycle workflows. Additionally, the role involves training stakeholders and standardizing criteria and workflows across entities.
Requirements
- 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
- CPCS or CPMSM required
- Candidates must be based in the United States.
- Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.
Nice To Haves
- Bachelor’s degree preferred (or equivalent experience)
Responsibilities
- 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)
Benefits
- 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 events to 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
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Associate degree
