Provider Credentialing Coordinator (Remote)

Navitus-Health-Solutions-Lumicera-Health-Services; United States; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – 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, working with NCPDP, HMS, DEA, and state/federal databases.

The position requires knowledge of pharmacy processing practices and strong verbal/written communication, with responsibility to ensure compliance with policies and URAC standards while supporting transition of providers

Qualifications

• Retail pharmacy or managed care experience preferred.
• Experience analyzing medical/pharmacy claims or credentials.
• Strong communication, data-mine and multitasking abilities.
• Interact professionally with providers at all levels.
• Proficient in Microsoft Office applications.
• Independent worker who collaborates across departments.

Responsibilities

• Process provider credentials receipts and first-level evaluations.
• Create reports on credential activity for governance.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Ensure URAC compliance and Navitus policies.
• Support vendor relationships and resolve processing requirements.
• Assist in credentialing for annual attestations (Fraud, Waste, and Abuse).
• Update systems with data matching external databases.
• Collaborate with Network Development on strategy.
• Perform other duties as assigned.

Skills

Retail pharmacy experience

Communication skills

Analytical skills

Independent work

Microsoft Office

Interpersonal skills

Education

High school or equivalent

Advanced degree preferred

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, working with NCPDP, HMS, DEA, and state/federal databases.

The position requires knowledge of pharmacy processing practices and strong verbal/written communication, with responsibility to ensure compliance with policies and URAC standards while supporting transition of providers