Credentialing Specialist

Aylo Health; Atlanta (GA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive compensation

Comprehensive benefits

Professional growth

Job summary

Aylo Health seeks a Credentialing Specialist to support verification, enrollment, and ongoing compliance for healthcare providers. You will ensure proper credentialing, appointments, and privileges with payers, hospitals, and care facilities to enable timely reimbursement.

The ideal candidate has hands-on PSV and provider data management across multiple systems in a fast-paced healthcare environment. Strong detail orientation and communication are essential for success.

Qualifications

• High school diploma or equivalent required.
• 5-7 years of provider credentialing, enrollment, or healthcare admin experience.
• Strong knowledge of credentialing processes and PSV.
• Experience with health plans, hospitals, and provider networks.
• Proficiency with credentialing software and verification systems.

Responsibilities

• Handle initial and re-credentialing applications for providers.
• Ensure timely and accurate submissions to payers and regulators.
• Serve as primary contact for credentialing requirements and status updates.
• Track progress with providers, payers, hospitals, and facilities.
• Maintain provider records across credentialing databases.

Skills

Attention to detail

Organization

Time management

Verbal communication

Written communication

Education

High school diploma or equivalent

Bachelor’s degree in healthcare administration or related field

Tools

Credentialing software

Databases

Online verification systems

Job description

At Aylo Health, we work together to enrich the health and well-being of every life we touch. Our mission is to make quality healthcare simple and convenient. Because healthy people can do amazing things!

We offer a work environment that values the creation of lifelong relationships, while also providing opportunities for growth and career development. We strive to care for each other with the same passion with which we care for our patients. Aylo Health offers competitive pay to team members who provide high-quality care, while delivering an exceptional patient experience.

Position Summary

We are seeking a detail-oriented and highly organized Credentialing Specialist to support the verification, enrollment, and ongoing compliance of healthcare providers. This role is critical to ensuring providers are properly credentialed, appointed, and privileged with payers, hospitals, and patient care facilities, enabling timely reimbursement and regulatory compliance.

The ideal candidate has hands‑on experience with provider credentialing and re‑credentialing, primary source verification (PSV), and managing provider data across multiple systems in a fast‑paced healthcare environment.

Key Responsibilities

Provider Credentialing & Enrollment

• Collect, review, and process initial and re-credentialing applications for healthcare providers.
• Ensure applications are complete, accurate, and submitted within required payer and regulatory timelines.
• Serve as a primary point of contact for providers regarding credentialing requirements, status updates, and follow-up items.
• Track application progress and proactively follow up with providers, payers, hospitals, and facilities.

Primary Source Verification (PSV)

• Perform and document primary source verification for provider credentials, including:
  • State professional licenses
  • DEA registrations
  • Board certifications
  • Education and training
  • Work history
  • Sanctions and exclusions (OIG, SAM, NPDB, CMS Preclusion List, etc.)
• Ensure all verification activities meet federal, state, payer, and accreditation standards.

Credentialing, Appointment & Privileging

• Complete credentialing, re-credentialing, and privileging processes to ensure providers are credentialed and appointed with:
  • Health plans and payers
  • Hospitals and health systems
  • Patient care facilities and networks
• Prepare credentialing files for review by Credentialing Committees, as applicable.
• Issue approval, denial, or deficiency communications in accordance with established policies.

Compliance & Quality Assurance

• Ensure compliance with federal and state regulations, payer requirements, and accreditation standards (e.g., NCQA, CMS).
• Maintain knowledge of current health plan and agency credentialing requirements.
• Adhere to internal policies, procedures, and delegated credentialing agreements.

Data Management & Reporting

• Maintain accurate and up-to-date provider records in credentialing databases and online systems.
• Track license, certification, DEA, and malpractice insurance expirations and ensure timely renewals.
• Prepare reports related to credentialing activity, provider rosters, accreditation, and privileging status.

Documentation & File Maintenance

• Maintain complete credentialing files, including copies of:
  • Current state licenses
  • DEA certificates
  • Malpractice insurance coverage
  • Board certifications and other required documentation
• Maintain corporate provider contract files aligned with credentialing records.
• Ensure confidentiality and security of all credentialing information.

Qualifications

Required

• High school diploma or equivalent.
• 5-7 years of experience in provider credentialing, provider enrollment, or healthcare administration.
• Strong knowledge of credentialing processes and primary source verification.
• Experience working with health plans, hospitals, and provider networks.
• Proficiency with credentialing software, databases, and online verification systems.
• Excellent attention to detail, organization, and time management skills.
• Strong written and verbal communication skills.

Preferred

• Associate’s or Bachelor’s degree in healthcare administration, business, or a related field.
• Experience with delegated credentialing programs.
• Familiarity with NCQA standards and CMS requirements.
• Credentialing certification (CPCS, CPMSM, or equivalent).

What We Offer

• Competitive compensation
• Comprehensive benefits package
• Supportive, collaborative team environment
• Opportunity to work in a mission-driven healthcare organization
• Professional growth and development opportunities

Aylo Health is an Equal Opportunity Employer