Provider Credentialing Coordinator — Remote Eligible

Navitus Health Solutions, LLC; Central City (KY); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K match

Adoption assistance

Flexible spending account

Educational assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in credentialing providers and maintaining compliance with federal and state regulations.

The role requires handling credentialing data, reporting, and interactions with multiple databases. It emphasizes independent work, strong communication, and adherence to Navitus’ policies to ensure a qualified pharmacy network.

Qualifications

• High school diploma or equivalent required; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical and/or pharmacy claims or credentials is highly desired.
• Ability to work independently with strong written and verbal communication skills; manage multiple priorities.

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in files; audit for non-compliance.
• Support URAC compliance and Navitus policies; update P&Ps as regulations change.
• Create reports of credential activity for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) for data quality.
• Assist in administering provider communications and pricing questions.

Skills

Credentialing

Data mining

Analytical skills

Telephonic communication

Written communication

Independent worker

Multitasking

Provider interaction

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in credentialing providers and maintaining compliance with federal and state regulations.

The role requires handling credentialing data, reporting, and interactions with multiple databases. It emphasizes independent work, strong communication, and adherence to Navitus’ policies to ensure a qualified pharmacy network.