Provider Credentialing Specialist - Remote

Navitus Health Solutions, LLC; Athens (GA); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off 20 days

Parental leave 4 weeks

9 holidays paid

401K match up to 5%

Adoption assistance

Flexible Spending Account

Educational assistance and membership

Referral bonus up to $750

Job summary

Navitus Health Solutions, LLC is hiring a Coordinator I, Provider Credentials to join our team. The role focuses on credential processing, reporting, and compliance across federal and state databases, with regular interactions with providers and pharmacies.

The position supports Navitus’ policy framework, URAC standards, and provider network integrity while collaborating with Pharmacy Relations and Contract Analysts to ensure accurate credentialing and timely reporting.

Qualifications

• Requires strong communication skills and ability to interact with providers at all levels.
• Experience analyzing medical and/or pharmacy claims or credentials is highly desired.
• Proficiency in Microsoft applications and ability to use data in multiple systems.

Responsibilities

• Daily communication 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 procedures to meet new regulations.
• Create reports of credential activity and submit to department leaders and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract required data.
• Assist with resolution of credentialing issues and pricing questions.
• Support annual attestations and other required attestations for Navitus business practices.
• Update systems to reflect external database data; ensure data accuracy.
• Assist leadership in developing and implementing pharmacy network strategies.
• Perform other duties as assigned.

Skills

Telephonic communication

Written communication

Analytical skills

Multi-tasking

Independent work

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions, LLC is hiring a Coordinator I, Provider Credentials to join our team. The role focuses on credential processing, reporting, and compliance across federal and state databases, with regular interactions with providers and pharmacies.

The position supports Navitus’ policy framework, URAC standards, and provider network integrity while collaborating with Pharmacy Relations and Contract Analysts to ensure accurate credentialing and timely reporting.