CrawlJobs Logo
Aylo Health Logo Aylo Health · IT - Administration

Credentialing Specialist

United States, Atlanta · Job Posted May 29, 2026
Apply Position
Job Link Share

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.

Job Responsibility

  • 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
  • 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
  • Issue approval, denial, or deficiency communications
  • Ensure compliance with federal and state regulations, payer requirements, and accreditation standards
  • 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
  • Maintain corporate provider contract files aligned with credentialing records
  • Ensure confidentiality and security of all credentialing information

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 have

  • 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 - All Job Offers

Looking for more opportunities?

Search for other job offers that match your skills and interests.

Suggested Tags: Frontend Developer Secretary Talent Manager Salesforce Administrator Data Analyst
Similar Jobs for

Credentialing Specialist

8 matching positions

Provider Credentialing Specialist

Work with the New Ventures team to complete health plan credentialing accurately...
Location
Location
United States
Salary
Salary:
55000.00 - 75000.00 USD / Year
pomelocare.com Logo
Pomelo Care
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2-4 years of experience in a high volume, credentialing specialist role
  • Deep expertise with commercial health plan credentialing processes, including health plan portals & CAQH
  • Highly organized with a strong attention to detail
  • A proactive and resourceful problem-solver who is comfortable navigating ambiguity and independently seeks out answers and solutions
  • An accountable and collaborative team player with excellent communication skills, both written and verbal
  • An expert at prioritization & time management, who proactively shares deliverable timelines and roadblocks
Job Responsibility
Job Responsibility
  • Complete group & practitioner health plan credentialing on behalf of Pomelo’s telehealth clinic & care team
  • Track applications from submission to approval, contracting, and agreement, ensuring cross-functional visibility into key milestones & timelines
  • Proactively mitigate application delays & denials
  • Rigorously follow up on any delays and/or denials to right-size
  • Collaborate with Pomelo licensing, credentialing, and enrollment team to ensure proper clinician licensure & up-to-date CAQH profiles, to help expedite health plan credentialing
  • Collaborates with care team of nurses, nurse practitioners, doctors, therapists & registered dietitians to support navigation & answer questions about clinician credentialing applications
What we offer
What we offer
  • Competitive healthcare benefits
  • Generous equity compensation
  • Unlimited vacation
  • Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)
Read More
Arrow Right

Medical Staff Credentialing Specialist and Coordinator

The Medical Staff Credentialing Specialist and Coordinator assists the Medical D...
Location
Location
United States , Medina
Salary
Salary:
50000.00 - 60000.00 USD / Year
orleanscommunityhealth.org Logo
Orleans Community Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associates Degree or Certified Provider Credentialing Specialist (CPCS)
  • A minimum of 2-3 Years Credentialing experience is preferred
  • Excellent verbal and written communication skills, ability to relate well with people of diverse backgrounds, training and experience
  • Proficiency with medical practice software programs, Familiarity with credentialing requirements of hospitals and insurance carriers
  • Understanding of Malpractice insurance coverages and policies
  • Knowledge and understanding of credentialing process
  • Ability to organize and prioritize work and manage multiply priorities
  • Ability to research and analyze data
  • Ability to work independently with minimal supervision
  • Ability to establish and maintain effective working relationships with providers, management, staff and external contacts
Job Responsibility
Job Responsibility
  • Compiles and maintains current and accurate data for all providers
  • Completes provider credentialing and re-credentialing applications, monitors applications and follow-up as needed
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
  • Maintains corporate provider contract files
  • Maintains knowledge of current health plan and agency requirements for credentialing providers
  • Sets up and maintains provider information in online credentialing databases and system
  • Tracks license and certification expirations for all providers to ensure timely renewals
  • Ensures practice addresses are current with health plans, agencies and other entities
  • Audits health plan directories for current and accurate provider information
  • Completes credentialing/re-credentialing application packets for hospital, insurance carriers and government programs
What we offer
What we offer
  • vacation and sick time
  • health, dental and vision
  • pension and retirement plan
  • competitive wages, with superior pension and retirement plans with employer contributions
  • 12% shift differential for working evening and night shifts
  • excellent vacation, holiday and sick leave package
  • tuition assistance
  • free parking
  • Fulltime
Read More
Arrow Right

Credentialing Specialist Lead

The Credentialing Specialist Lead serves as the senior subject matter expert wit...
Location
Location
United States , Long Island City
Salary
Salary:
30.00 - 32.00 USD / Hour
thedermspecs.com Logo
The Dermatology Specialists
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3+ years of healthcare credentialing experience
  • dermatology or multispecialty experience preferred
  • Strong knowledge of CAQH, NPPES, Medicaid, Medicare, and commercial payer portals
  • Exceptional attention to detail, organization, and follow-through
  • Excellent communication and interpersonal skills
  • Proficiency in Excel and credentialing systems
  • experience with eClinicalWorks a plus
Job Responsibility
Job Responsibility
  • Manage the full credentialing lifecycle for physicians, NPs, and PAs — including Medicaid, Medicare, and commercial payer enrollments (Empire BCBS, Fidelis, Aetna, etc.)
  • Review and verify provider documents such as medical licenses, DEA, board certifications, malpractice coverage, and CVs
  • Prepare, track, and submit enrollment applications accurately and within payer timelines
  • Monitor revalidation and re-credentialing schedules to ensure ongoing compliance
  • Serve as the primary point of contact for escalated payer or provider inquiries
  • Partner with internal billing and operations teams to ensure credentialing aligns with billing readiness
  • Maintain credentialing logs, dashboards, and internal trackers for reporting purposes
  • Assist in training and supporting new credentialing specialists, ensuring quality and consistency across workflows
Read More
Arrow Right

Credentialing Specialist

The Credentialing Specialist will be responsible for timely submission and follo...
Location
Location
United States , Overland Park
Salary
Salary:
Not provided
ariacarepartners.com Logo
Aria Care Partners
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Minimum two years of health insurance credentialing experience preferred
  • Prior data management/data integrity experience preferred
  • Associates degree preferred
  • Proficient with Microsoft Office, including Excel, Word, and Outlook
  • Excellent organization and communication skills
  • Quick thinking, positive, and professional, with demonstrated problem solving, attention to detail, and critical thinking skills
  • Ability to work independently, set priorities, and meet deadlines
  • Adapt to changes in work environment, manage competing demands and deal with frequent change, delays, or unexpected events
  • Able to work in a team environment
Job Responsibility
Job Responsibility
  • Prepare and submit credentialing applications and supporting documentation for the purpose of enrolling groups and providers with Commercial, Medicare, and Medicaid networks
  • Follow up on the status of applications for providers with payers, tracking progression of pending and completed work
  • Maintains accurate and up-to-date database of information including provider credentials and payer statuses
  • Works closely with internal teams to communicate approvals and work through denials as necessary
  • Maintains knowledge of current payer requirements across multiple states and service lines
  • Maintain strict level of confidentiality and HIPAA compliance
  • Familiarity with state licensing requirements and provider onboarding tasks
  • Familiarity with various payer portals and CAQH
  • Contact providers and payers, by phone or email, for updates and/or to request missing information
  • Ensure group and provider information is current/accurate with health insurance payers
What we offer
What we offer
  • PTO and Paid Holidays for FT Employees
  • 401k Retirement Plan with Company Match
  • Insurance programs including medical, dental, vision, company match for your HSA, FSA, company-paid EAP, and life and disability insurance, and more
  • Fulltime
Read More
Arrow Right

Client Partner – Credentialing Specialist

Join our team in Manila as a Client Partner - Credentialing Specialist. We are s...
Location
Location
Philippines , Taguig City
Salary
Salary:
Not provided
accesshealthcare.com Logo
Access Healthcare LLC
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Strong knowledge of Payer Processes and Credentialing
  • Willingness to work continuously in night shifts
  • Must be fluent in English language
  • Willing to work in the night shift at our office in McKinley Hill, Taguig
  • Must have at least 1 year of experience in Credentialing processes for US healthcare customers
Job Responsibility
Job Responsibility
  • Manage the end-to-end provider enrollment process, ensuring healthcare providers are properly credentialed and enrolled with insurance networks
  • Conduct thorough review of provider documentation, ensuring compliance with credentialing requirements and proactively resolving any discrepancies
  • Serve as a liaison between healthcare providers and insurance companies, addressing enrollment-related inquiries and facilitating timely resolution
  • Maintain accurate and up-to-date provider information in databases, and collaborate with internal teams to streamline the enrollment and billing processes
Read More
Arrow Right

Human Resources Credentialing and Compliance Specialist

The Human Resources Credentialing and Compliance Specialist is responsible for s...
Location
Location
United States , Irving
Salary
Salary:
Not provided
christushealth.org Logo
CHRISTUS Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s degree in Management, Business, Human Resources, or a related field is preferred
  • Excellent verbal and written communication skills
  • Ability to work independently with minimal direction, leverage all available resources, and effectively solve problems
  • Must be proficient in Microsoft Office (Excel, Outlook, PowerPoint, and other web-based applications)
  • Ability to scrub, analyze, and interpret data from multiple sources
  • 2 - 4 years of compliance in HR or Healthcare experience preferred
  • Customer service experience is preferred
  • Experience working with a Human Resources Information System (HRIS) preferred
  • aPHR, PHR, SHRM-CP, or equivalent certification is preferred
Job Responsibility
Job Responsibility
  • Uphold and reinforce internal policy standards, guiding as appropriate to reduce risks while ensuring regulatory compliance
  • Align with internal processes and cascade process expectations to HR partners, leaders, and Associates as we strive to standardize efforts across all ministry locations
  • Maintain accurate record-keeping within the HRIS, third-party systems, shared folders or drives, and any other location where information is stored or shared
  • Process project-related data entry in compliance with job requirements and healthcare standards, ensuring a seamless workflow with no gaps
  • Run ad hoc reports and interpret the data
  • Draw insights by identifying trends and gaps through data analysis and format the information in a way that is easily digestible by the intended audience
  • Routinely perform audits on LCR data to ensure integrity, identify opportunities for improvement, clean-up, or correction, and provide recommendations
  • Assist in the design and implementation of process improvements by working closely with stakeholders to assess, develop, and implement process changes or remediation plans for identified HR-related issues, including, but not limited to, workforce licensing requirements
  • Routinely troubleshoot and resolve interface and license verification errors
  • Provide input and participate in projects where LCR is a stakeholder, as necessary, to achieve strategic goals and objectives
  • Fulltime
Read More
Arrow Right

Credentialing Auditor

Responsible for auditing all complete credentialing applications and to build so...
Location
Location
United States , Irving
Salary
Salary:
Not provided
christushealth.org Logo
CHRISTUS Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree preferred
  • High School or equivalent required
  • 3 years of experience in medical staff and/or managed care credentialing preferred
  • Certified Provider Credentialing Specialist (CPCS) preferred
Job Responsibility
Job Responsibility
  • Coordinate and conduct credentialing audits analyzing provider files for completeness, accuracy, consistency, gaps in work history, relevant references, etc.
  • Prepare credentialing audit reports tracking and trending auditor findings and assist in the formulation of staff training guides, policies and procedures
  • Manages multiple concurrent audits, plan audits and related projects ensuring all audit tools comply with NCQA, TJC and CMS requirements
  • Coordinates the credentialing and re-credentialing process for assigned providers
  • Fulltime
Read More
Arrow Right

Senior Credentialing Specialist

The Senior Credentialing Specialist is responsible for the credentialing and rec...
Location
Location
United States
Salary
Salary:
61300.00 - 99620.00 USD / Year
healthfirst.org Logo
Healthfirst
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 5+ years of proven credentialing experience
  • Facilities experience
  • Bachelor’s degree or equivalent combination of education and experience
  • Proficiency in MS Word, Excel, Outlook
  • Superior organizational and follow up skills
  • Strong attention to detail
Job Responsibility
Job Responsibility
  • Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc
  • Perform credentialing and recredentialing of non-delegated providers and vendors, facilities and groups in accordance with established credentialing policies and procedures and NYS and CMS credentialing regulations
  • Work collaboratively with Vendor Management Specialist and designated Credentialing Verifications Organization (CVO) and audit monthly files
  • Prepare, review, update and/or audit committee summaries and present them to the Credentialing Committee as applicable
  • Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders
  • Troubleshoot issues and outreach to necessary internal and external contacts as required to obtain credentialing and recredentialing documents
  • Actively participate with and support the development of internal provider systems used to intake, track and monitor provider credentialing
  • Develop job aids, workflows, and policies as procedures and systems evolve
  • Prepare bi-weekly clean file approval lists for medical directors
  • Additional duties/tasks as assigned
What we offer
What we offer
  • Medical, dental and vision coverage
  • Incentive and recognition programs
  • Life insurance
  • 401k contributions
  • Fulltime
Read More
Arrow Right