| Location | Chicago, IL |
The Manager, Credentialing & Enrollment owns the credentialing and payer-enrollment operations for Transcarent providers across all practitioner types. This role establishes reliable, compliant, and scalable processes for initial credentialing, re-credentialing, primary source verification, payer enrollment, delegated credentialing, and provider-readiness coordination.
The Manager leads day-to-day operations across the credentialing and enrollment lifecycle, maintains audit-ready provider files, manages relationships with delegated credentialing entities and enrollment partners, and serves as a key partner to Licensing, Clinic Operations, Medical Group Operations, Compliance, Legal, Finance, Workforce Management, and external vendors and payers.
The successful candidate combines strong healthcare credentialing and payer-enrollment expertise with operational discipline, people leadership, sound judgment, and the ability to build systems that support safe, compliant, and uninterrupted care delivery. The role is cross-trained to support licensing functions during absences, capacity constraints, or volume surges.
A day in the life...
Credentialing strategy and program ownership
Own initial credentialing and re-credentialing cycles for all practitioner types.
Establish and maintain credentialing workflows, service levels, escalation pathways, documentation standards, and quality-control checks.
Lead primary source verification and ensure credentialing files are complete, accurate, secure, and NCQA-compliant.
Coordinate with providers to collect complete and accurate materials, resolve deficiencies promptly, and communicate requirements and timelines clearly.
Maintain a clear distinction between credentialing, privileging, licensure, payer enrollment, and clinic readiness while coordinating handoffs among those processes.
Translate clinical growth plans, coverage requirements, payer needs, and provider-readiness milestones into actionable credentialing plans.
Payer enrollment and delegated credentialing
Manage payer enrollment processes for all applicable providers, including delegated payer enrollments and BSC enrollment activities following recontracting.
Establish submission, follow-up, effective-date, revalidation, roster, and status-tracking processes for payer enrollment.
Manage relationships with delegated credentialing entities, payers, and enrollment partners; serve as the escalation point for delays, deficiencies, and exceptions.
Partner with Licensing, Clinic Operations, and Medical Group Operations to align credentialing and payer-enrollment completion with licensure, committee review, privileging, and clinic-readiness milestones.
Monitor enrollment status, open items, turnaround times, effective dates, and operational risks; escalate complex, delayed, or adverse matters to the appropriate stakeholders.
Quality, compliance, and accreditation readiness
Lead credentialing file audits and NCQA accreditation-readiness activities; identify gaps and implement corrective actions.
Ensure credentialing and enrollment processes align with applicable federal and state requirements, medical group policies, accreditation standards, payer requirements, and internal controls.
Support internal and external audits, accreditation activities, payer reviews, regulatory inquiries, and other information requests.
Conduct root-cause analysis for incomplete files, preventable delays, missed deadlines, recurring process defects, and enrollment issues.
Maintain complete and secure provider records in accordance with record-retention, privacy, and information-security requirements.
Committee, vendor, and program leadership
Prepare and support Provider Credentialing Quality Council (PCQC) and Credentialing Peer Review Committee (CPRC) meetings, materials, decisions, and follow-up actions.
Manage credentialing, enrollment, and related vendor relationships, including Verifiable, Mocingbird, NetCE, CAQH, and comparable partners.
Maintain and update policies and procedures for the credentialing and enrollment programs, ensuring processes remain standardized, current, and audit-ready.
Develop communication templates, FAQs, checklists, and educational resources that make the credentialing and enrollment process easy to understand and follow.
Participate in cross-functional planning for new services, new states, provider expansion, clinic coverage, payer changes, and changes to the Transcarent Clinic operating model.
Reporting, dashboards, and operational controls
Prepare recurring reports and dashboards covering credentialing status, payer-enrollment milestones, file completeness, application volumes, turnaround times, open deficiencies, exceptions, readiness, and operational risk.
Report quality metrics and manage dashboards that provide clear visibility into performance, aging work, upcoming deadlines, and provider readiness.
Establish quality-assurance reviews to validate data accuracy, documentation completeness, adherence to standard processes, and timely escalation.
Identify opportunities to standardize and automate workflows, reduce manual work, and improve visibility across credentialing and enrollment operations.
Coordinator leadership and cross-functional support
Provide oversight, workload direction, and prioritization for the Credentialing Coordinator's day-to-day verification and enrollment work.
Ensure timely completion of data entry, tracking updates, document collection, primary source verification follow-ups, enrollment work, and renewal-related support across shared workstreams.
Maintain shared trackers and dashboards and ensure time-sensitive items-including audit deadlines, enrollment delays, and provider-readiness risks-are escalated to the appropriate manager or stakeholder.
Provide cross-functional coverage for licensing functions when licensing capacity is constrained or unavailable.
Required qualifications
Bachelor's degree in healthcare administration, nursing, business, public health, or a related field.
Five or more years of experience in healthcare provider credentialing, payer enrollment, delegated credentialing, licensure, medical group operations, provider network operations, or a closely related field.
Demonstrated experience leading initial credentialing, re-credentialing, primary source verification, payer enrollment, or delegated credentialing workflows.
Working knowledge of NCQA credentialing standards, payer enrollment requirements, delegated credentialing models, provider files, and healthcare regulatory expectations.
Experience managing sensitive provider information and maintaining accurate, secure, audit-ready records.
Strong attention to detail, prioritization, documentation, process-improvement, and risk-escalation skills.
Excellent written and verbal communication skills, with the ability to work effectively with clinicians, executives, payers, vendors, regulators, and cross-functional partners.
Strong proficiency with spreadsheets, reporting tools, workflow systems, credentialing platforms, and Microsoft Office.
Preferred qualifications
Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM), or comparable credential.
Active clinical license or professional credential in a relevant discipline.
Experience supporting a virtual care, telehealth, primary care, urgent care, or multi-state medical group.
Experience with delegated credentialing, payer enrollment, privileging, NPDB processes, CAQH, Verifiable, Salesforce, or comparable provider-management platforms.
Experience supporting NCQA, URAC, Joint Commission, CMS, state medical-board, or payer audits.
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. For more information, visit transcarent.com, and follow us on LinkedIn.
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.