Credentialing Specialist

Thank you for considering Progyny!

As Credentialing Specialist, you are responsible for coordinating and performing credentialing functions including primary source verification, annual due diligence audits, and monitoring of practitioner activities to ensure compliance with National Committee for Quality Assurance (NCQA), contractual agreements, and State and Federal requirements.

What you'll do...

• Completing primary source verification and file review of practitioner credentialing files.

• Demonstrating a solid understanding of NCQA guidelines around Credentialing

• Submitting credentialing applications and completing all associated follow up on those applications.

• Verifying the accuracy of all submitted credentialing information, and ensure accuracy of Primary Source Verification (PSV) documents for credentialing

• Performing all activities related to practitioner credentialing including but not limited to identifying discrepancies in information and conducting follow up, presenting applications to the Credentialing Committee, assisting customers with credentialing inquiries, responding to health plan provider inquiries, capturing primary source documentation, ensuring data is backed up, etc.

• Conduct research on updated state and federal regulations and policies

• Maintaining and ensuring compliance with credentialing policies and procedures.

• Assist in training staff on current NCQA standards as appropriate to job functions.

• Serve as a resource for other departments for compliance with credentialing standards.

• Participate in delegation audits, supplying information as needed.

• Perform tasks related to external audits from contracted health plans/employer groups as well as pre-delegation review with potential health plans as required.

• Coordinate facets of NCQA accreditation process including ensuring all activities, documentation, and evidence necessary for the accreditation are prepared in compliance with accreditation standards.

• Ensuring accuracy in provider directory information including but not limited to board certification, education, and practitioner type

• Perform other duties as assigned.

About you...

• Bachelor's degree in health care related field.

• CPCS Certification preferred

• Two to three years of provider credentialing with a strength in NCQA and HIPAA preferred.

• Proven track record of working with external regulatory and compliance partners for client relationship management and consultation within healthcare.

• Excellent messaging, positioning, and presentation of policy development, audit, and compliance.

• Strong project management skills - identify a goal and the steps needed; actively manage action steps to accomplish goal while managing and holding key stakeholders accountable.

• Excellent compliance acumen; strong problem-solving, judgment and analytic skills.

• Ability to meet strict deadlines

• Attention to detail

• Prior experience and success in a fast-growing organization.

Please note: 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: $75,000 - $85,000. 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 Affirmative Action employer.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 apply@progyny.com.

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