Credentialing Specialist

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.

Location: Atlanta, GA

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

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