Credentialing Specialist

Aylo Health, LLC; Atlanta (GA); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Competitive compensation

Collaborative team environment

Mission-driven organization

Professional growth opportunities

Job summary

Aylo Health, LLC is seeking a detail-oriented Credentialing Specialist to support verification, enrollment, and ongoing compliance of providers. You will manage PSV, track licenses, certifications, and renewals, and prepare credentialing files for review by committees.

The role requires experience with provider credentialing, relationships with health plans and hospitals, and strong data management skills. Primarily remote with occasional in-office meetings in Atlanta, GA.

Qualifications

• 5-7 years of experience in provider credentialing, provider enrollment, or healthcare administration.
• Strong knowledge of credentialing processes and primary source verification.
• Excellent attention to detail, organization, and time management skills.
• Strong written and verbal communication skills.

Responsibilities

• 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.
• Perform and document primary source verification for state licenses, DEA registrations, board certifications, education and training, work history, and sanctions/exclusions.
• Ensure all verification activities meet federal, state, payer, and accreditation standards.
• Complete credentialing, re-credentialing, and privileging processes with health plans, hospitals, and networks.
• Prepare credentialing files for review by Credentialing Committees.

Skills

Provider credentialing

Primary source verification (PSV)

Attention to detail

Organization

Time management

Communication skills

Credentialing software

Online verification systems

Education

Associate/Bachelor’s degree in healthcare administration or related field

Credentialing certification (CPCS/CPMSM)

Tools

Credentialing software

Online verification systems

Job description

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.

Location: Atlanta, GA

Schedule: Monday through Friday 8:00 AM to 5:00 PM. Primarily remote with occasional in office meetings.

Key Responsibilities

• 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.
• 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:
• 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
• Supportive, collaborative team environment
• Opportunity to work in a mission-driven healthcare organization
• Professional growth and development opportunities

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Aylo Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.