Provider Credentialing Coordinator (Remote)

Navitus Health Solutions, LLC; Guin (AL); A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health, Dental, Vision

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

FSA

Education assistance

Referral bonus

Descripción de la vacante

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

You will work with NCPDP, HMS, DEA, state boards, and federal databases, reporting to the Manager of Provider Services to ensure qualified pharmacies and providers are credentialed.

Formación

• High school or equivalent required; advanced degree preferred.
• Experience in medical or pharmacy claims/credentials is highly desirable.
• Strong communication and data-analysis skills with ability to manage multiple priorities.

Responsabilidades

• Communicate daily with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in contract files; audit for compliance.
• Support URAC compliance and Navitus policies; update policies to reflect new statutes or guidance.
• Create reports on credential activity for department leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract required data.
• Assist network development in evaluating pharmacy network strategies and implementations.
• Support attestations for Fraud, Waste, and Abuse and other required attestations.

Conocimientos

Independent work

Communication

Data mining

Analytical skills

Multitasking

Educación

High school or equivalent

Advanced degree preferred

Herramientas

Microsoft Office

Descripción del empleo

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

You will work with NCPDP, HMS, DEA, state boards, and federal databases, reporting to the Manager of Provider Services to ensure qualified pharmacies and providers are credentialed.