Provider Credentialing Coordinator - Remote

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

Ventajas ofrecidas por este puesto de trabajo

Top benefits for Health, Dental, and V

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro

Referral Bonus Program – up to $750!

Descripción de la vacante

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on obtaining, reviewing, and processing provider credentials, ensuring compliance with URAC standards and federal/state regulations.

You will work with NCPDP, HMS, DEA and multiple provider databases, generate credential reports for leadership, and support credentialing activities across Navitus' pharmacy network while maintaining high quality service.

Formación

• High school diploma or GED; advanced degree preferred.
• Experience in retail pharmacy or managed care setting.
• Experience analyzing medical/pharmacy claims or credentials.
• Ability to work independently with strong communication and multitasking.
• Proficient with Microsoft applications.
• Ability to interact professionally with providers at all levels.

Responsabilidades

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensures credentials are documented and audited for compliance.
• Supports URAC compliance and policy updates.
• Create reports of credential activity for VP and Credential Committees.
• Monitors credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Support Pharmacy Network in pricing questions and processing requirements.
• Assist in Fraud, Waste, and Abuse attestations.
• Update systems with data from external databases.
• Assist in network strategy review and implementation.
• Other duties as assigned.

Conocimientos

Independent work

Telephonic communication

Written communication

Data mining

Analytical skills

Educación

High school or equivalent

Advanced degree preferred

Herramientas

Microsoft Office

Descripción del empleo

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on obtaining, reviewing, and processing provider credentials, ensuring compliance with URAC standards and federal/state regulations.

You will work with NCPDP, HMS, DEA and multiple provider databases, generate credential reports for leadership, and support credentialing activities across Navitus' pharmacy network while maintaining high quality service.