Credentialing Coordinator

Summary

Transcarent is a health and care company providing integrated medical, pharmacy, and care solutions. The Credentialing Coordinator executes provider credentialing and re-credentialing operations, including primary source verification, licensing, payer workflows, and audit support. The role collaborates with operations, compliance, quality, provider relations, and network teams to maintain accurate, compliant, and audit-ready credentialing files.

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 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 escalate 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

• 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
• 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 entities
• Experience supporting NCQA accreditation preparation or audit readiness

Qualifications

Must Haves

• 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

Nice to Haves

• 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 entities
• Experience supporting NCQA accreditation preparation or audit readiness

Benefits

• All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.
• 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