Credentialing Specialist

Aylo Health•Atlanta, GA

18d•Remote

About The Position

Aylo Health is seeking a detail-oriented and highly organized Credentialing Specialist to support the verification, enrollment, and ongoing compliance of healthcare providers. The role helps ensure providers are properly credentialed, appointed, and privileged with payers, hospitals, and patient care facilities, supporting timely reimbursement and regulatory compliance. The ideal candidate has hands-on experience with provider credentialing and re-credentialing, primary source verification, and provider data management across multiple systems in a fast-paced healthcare environment. The position is based in Atlanta, Georgia, and is primarily remote with occasional in-office meetings. The schedule is Monday through Friday, 8:00 AM to 5:00 PM. The specialist works with providers, payers, hospitals, facilities, and internal committees to process applications, verify credentials, maintain records, communicate decisions, and support compliance with applicable regulatory, payer, and accreditation requirements.

Requirements

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.

Nice To Haves

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 such as CPCS, CPMSM, or equivalent.

Responsibilities

Collect, review, and process initial and re-credentialing applications for healthcare providers.
Ensure applications are complete, accurate, and submitted within payer and regulatory timelines.
Serve as a primary contact for providers regarding credentialing requirements, status updates, and follow-up items.
Track application progress and follow up with providers, payers, hospitals, and facilities.
Perform and document primary source verification of state professional licenses, DEA registrations, board certifications, education and training, work history, sanctions, and exclusions.
Ensure verification activities meet federal, state, payer, and accreditation standards.
Complete credentialing, re-credentialing, and privileging processes for health plans and payers, hospitals and health systems, and patient care facilities and networks.
Prepare credentialing files for Credentialing Committee review, as applicable.
Issue approval, denial, or deficiency communications according to established policies.
Ensure compliance with applicable regulations, payer requirements, accreditation standards, internal policies, procedures, and delegated credentialing agreements.
Maintain current knowledge of health plan and agency credentialing requirements.
Maintain accurate and up-to-date provider records in credentialing databases and online systems.
Track license, certification, DEA, and malpractice insurance expiration dates and ensure timely renewals.
Prepare reports on credentialing activity, provider rosters, accreditation, and privileging status.
Maintain complete credentialing files, including licenses, DEA certificates, malpractice insurance coverage, board certifications, and other required documentation.
Maintain corporate provider contract files aligned with credentialing records.
Protect the confidentiality and security of credentialing information.