Provider Credentialing Coordinator – Remote

Navitus; Baton Rouge (LA); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating credential receipts, processing, and first level evaluation for internal and external reports.

You will work with NCPDP, HMS, DEA, and State/Federal databases to ensure qualified providers participate in Navitus' networks. The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to maintain URAC-compliant credentialing and

Qualifications

• Retail or managed care pharmacy experience is preferred.
• Able to analyze medical/pharmacy claims or credentials.
• Able to work independently with strong written and verbal communication.
• Able to mine data from multiple databases and manage competing priorities.
• Proficient in Microsoft Office applications.
• Familiar with Navitus’ business concepts, practices and policies.

Responsibilities

• Facilitate receipt, processing, and first level evaluation of credentials.
• Create and present credential reports to VP and Credential Committees.
• Audit credential files for compliance and update systems accordingly.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards).
• Support network development and pricing resolution activities.
• Coordinate annual attestations (Fraud, Waste, and Abuse).
• Assist in pharmacy network strategies with cross-functional teams.
• Perform other duties as assigned.

Skills

Pharmacy experience

Independent work

Strong communication

Data mining

MS Office

Multitask efficiently

Regulatory knowledge

Education

High school or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating credential receipts, processing, and first level evaluation for internal and external reports.

You will work with NCPDP, HMS, DEA, and State/Federal databases to ensure qualified providers participate in Navitus' networks. The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to maintain URAC-compliant credentialing and