Credentialing and Delegation Manager

Thank you for considering Progyny!
As Credentialing and Delegation Specialist, you responsible for coordinating and performing all credentialing functions including pre-delegation and annual due diligence audits and monitoring of practitioner and delegated credentialing activities to ensure compliance with National Committee for Quality Assurance (NCQA), contractual agreements, and State and Federal requirements.
What you'll be doing:

• The primary role of the Credentialing and Delegation Specialist is to complete, both, delegated and traditional credentialing files accurately.
• Demonstrate a solid understanding of Credentialing and NCQA guidelines around Credentialing and Provider Network
• Submitting initial credentialing applications, and all associated follow up on those applications.
• Verifying the accuracy of all submitted credentialing information, and for creating, or auditing accurate Primary Source Verification (PSV) files for delegated credentialing through CAQH and maintain NCQA Credentialing/Recredentialing Accreditation
• Performing all activities related to physician credentialing, re-credentialing, and Delegation 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, ensuring compliance with all applicable laws, regulations, procedures, and policies.
• Ensuring compliance to delegation agreements.
• Maintaining credentialing policies and procedures.
• Assist in training in 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 with delegated partners to ensure adherence to all regulations, contractual agreements, NCQA, HIPAA, and URAC guidelines.
• Analyze delegation audit results and makes recommendations for improvement. Ensure compliance with policies and procedures designed to ensure compliance with NCQA, applicable federal laws, regulations, and Delegation requirements.
• Coordinate all facets of NCQA accreditation/approval process including ensuring all activities, documentation, and evidence necessary for the accreditation are prepared in compliance with accreditation standards.
• Perform other duties as assigned.

About you:

• Bachelor's or Master's degree in health care related field.
• CPCS Certification preferred.
• Two 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.
• Prior experience and success in a fast-growing organization.

About Progyny:
Progyny is a leading fertility benefits management company in the US. We are redefining fertility and family building benefits, proving that a comprehensive and inclusive fertility solution can simultaneously benefit employers, patients, and physicians. Our benefits solution empowers patients with education and guidance from a dedicated Patient Care Advocate (PCA), provides access to a premier network of fertility specialists using the latest science and technologies, reduces healthcare costs for the nation's leading employers, and drives optimal clinical outcomes. We envision a world where anyone who wants to have a child can do so.
Our mission is to make any member's dream of parenthood come true through a healthy, timely, and supported fertility and family building journey.
Come join a company that's been recognized by Modern Healthcare as one of the Best Places to Work in Healthcare.
Our perks:

• Family friendly benefits: Paid maternity and paternity, fertility benefits (including egg freezing and IVF), emergency childcare program, parent's group
• Health, dental, vision and life insurance options for employees and family
• Paid vacation and summer flex time
• Company equity
• Bonus program
• 401k Match
• Company social events
• Flex days (3 days a week in the office) for positions located at NY office

In compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $90,000-110,000. 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 an Equal Opportunity Employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce.