Credentialing Coordinator

Transcarent; United States; On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

401(k) plan

Paid time off

Life Insurance

Wellness benefits

Job summary

Transcarent is seeking a Credentialing Coordinator to manage day-to-day credentialing and re-credentialing, ensuring NCQA-compliant files for our provider network.

You will perform primary source verification, review data, and collaborate with cross-functional teams to resolve issues and support audits. This role emphasizes accuracy, efficiency, and timely turnaround in a fast-paced health care innovator.

Qualifications

• Bachelor's degree in healthcare, business, or a related field, or equivalent experience.
• 3+ years of experience in provider credentialing, medical staff services, healthcare operations, or a related operational role
• Working knowledge of NCQA credentialing standards and primary source verification requirements
• Familiarity with provider licensure requirements across multiple states
• Strong analytical and problem-solving skills, with the ability to review detailed information and make sound decisions
• Highly organized and detail-oriented, with the ability to manage multiple tasks and priorities
• Comfortable working independently and as part of a team, with minimal direct supervision
• Results-oriented, with experience meeting productivity, quality, and turnaround expectations
• Excellent interpersonal and communication skills; willingness to ask questions, speak up, and seek clarity when needed
• Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support urgent operational needs

Responsibilities

• Execute day-to-day credentialing and re-credentialing work in support of our provider network, ensuring timely, accurate, and compliant completion of assigned deliverables
• Process initial credentialing and re-credentialing applications by reviewing provider files against NCQA standards, payer requirements, and internal guidelines
• Perform primary source verification, including licensure, board certification, education, work history, malpractice history, and sanctions checks
• Execute supporting tasks related to delegated credentialing audits and payer credentialing submissions
• Partner closely with the credentialing team members to help manage caseload, meet turnaround times, and maintain file quality
• Collaborate with provider relations, licensing, compliance, and network operations partners to resolve questions, issues, escalations, and delays
• Review provider data, applications, and supporting documentation to identify discrepancies, expirables, or items requiring follow-up
• Document findings clearly in the credentialing database and elevate non-standard situations when appropriate
• Follow established policies, procedures, and workflows while maintaining a high level of detail and accuracy in preparation for internal and external audits

Skills

Analytical mindset

Detail-oriented

Independent worker

Strong communication

Education

Bachelor's degree in healthcare, business, or related field

Tools

Verifiable

Availity

CAQH

Job description

The Credentialing Coordinator is responsible for the day-to-day operational execution of our provider credentialing and re-credentialing processes, helping ensure our provider network remains compliant and audit ready.

In this role, you will support initial credentialing, re-credentialing, primary source verification, payer and delegated credentialing workflows, and licensing. You will be a key member of the medical group operations team and partner with cross-functional operations team members, compliance, and quality team stakeholders to complete credentialing files accurately, efficiently, and in alignment with NCQA standards, payer requirements, and medical group policies and procedures.

The ideal candidate is a strong doer with an analytical mindset who is comfortable working in the details, following established processes, identifying issues, and helping drive timely resolution. This role is best suited for someone who enjoys executing credentialing operations at a high level , with an eye for efficiency.

What you'll do

• Execute day-to-day credentialing and re-credentialing work in support of our provider network, ensuring timely , accurate , and compliant completion of assigned deliverables
• Process initial credentialing and re-credentialing applications by reviewing provider files against NCQA standards, payer requirements, and internal guidelines
• Perform primary source verification, including but not limited to licensure, board certification, education, work history, malpractice history, and sanctions checks
• Execute supporting tasks related to delegated credentialing audits and payer credentialing submissions
• Partner closely with the credentialing team members to help manage caseload, meet turnaround times, and maintain file quality
• Collaborate with provider relations, licensing, compliance, and network operations partners to resolve questions, issues, escalations, and delays
• Review provider data, applications, and supporting documentation to identify discrepancies, expirables , or items requiring follow-up
• Document findings clearly in the credentialing database and elevate non-standard situations when appropriate
• Follow established policies, procedures, and workflows while maintaining a high level of detail and accuracy in preparation for internal and external audits

What we're looking for

• Bachelor's degree in healthcare, business, or a related field, or equivalent relevant experience
• 3+ years of experience in provider credentialing, medical staff services, healthcare operations, or a related operational role
• Working knowledge of NCQA credentialing standards and primary source verification requirements
• Familiarity with provider licensure requirements across multiple states
• Strong analytical and problem-solving skills, with the ability to review detailed information and make sound decisions
• Highly organized and detail-oriented, with the ability to manage multiple tasks and priorities
• Comfortable working independently and as part of a team, with minimal direct supervision
• Results-oriented, with experience meeting productivity, quality, and turnaround expectations
• Excellent interpersonal and communication skills; willingness to ask questions, speak up, and seek clarity when needed
• Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support urgent operational needs

Preferred Qualifications

• Experience with NCQA delegated credentialing audits or payer-specific credentialing requirements
• Familiarity with credentialing databases or platforms (e.g., Verifiable, Availity, CAQH, etc )
• Experience working with health plans, hospitals, or delegated credentialing entitiesExperience supporting NCQA accreditation preparation or audit readiness

Who We Are

Transcarent is the One Place for Health and Care, bringing medical, pharmacy, and point solutions together with the WayFinding experience, the first and only generative AI-powered health and care platform for health consumers.

Our WayFinding experience, paired with transparent and consumer-driven pharmacy care, 2nd.MD expert medical opinions, and virtual primary care, works seamlessly with comprehensive Care Experiences – Cancer Care, Surgery Care, and Weight Health – to support people with all of their health needs, simple or serious. More than 1,700 employers and health plans rely on us to provide information, guidance, and care, empowering health consumers with more choice, an experience they love, access to higher-quality care, and lower costs for 21 million Members.

At Transcarent, Our Values Guide Everything We Do

• People First: We prioritize our Members, clients, and each other in every decision
• Care: Every decision starts with improving health and care for our Members
• Resilience: We push boundaries and take the uncharted path to change an industry
• Results: We take ownership, solve with speed, and deliver for our people and each other
• Humble and Human: We lead with humility, bring fun to tough moments, and go further together

Total Rewards

Individual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity. Salary is just one component of Transcarent's total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.

Our benefits and perks programs include, but are not limited to:

• Competitive medical, dental, and vision coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 13 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits

Transcarent is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out!

Research shows that candidates from underrepresented backgrounds often don’t apply unless they meet 100% of the job criteria. While we have worked to consolidate the minimum qualifications for each role, we aren’t looking for someone who checks each box on a page; we’re looking for active learners and people who care about disrupting the current health and care with their unique experiences.