Credentialing Specialist
Share
Job Location:
Atlanta, GA - USA
Monthly Salary:
Not Disclosed
Posted on:
19 hours ago
Vacancies:
1 Vacancy
Job Summary
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
- Associates or Bachelors 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
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Aylo Health combines the services of a large healthcare system with the care and convenience of a primary care doctor. Book an appointment today!
