Aylo Health · 13 hours ago
Credentialing Specialist
Riverwood Corporate Office at Atlanta
Full-time
Onsite
Senior Level
5+ years expAylo Health is dedicated to enriching the health and well-being of every life they touch. They are seeking a detail-oriented Credentialing Specialist to support the verification, enrollment, and compliance of healthcare providers, ensuring timely reimbursement and regulatory compliance.
Health CareHealth DiagnosticsMedicalPrimary and Urgent Care
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 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
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
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
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
Qualification
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)
Benefits
Comprehensive benefits package
Supportive, collaborative team environment
Opportunity to work in a mission-driven healthcare organization
Professional growth and development opportunities
Company
Aylo Health
Aylo Health provides primary care, endocrine care, pediatric care, and imaging services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
N
Nick Williams
CEO
Recent News
Coverager - Insurance news and insights
2025-03-26
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