Provider Credentialing Specialist - Remote

Navitus Health Solutions, LLC; Eagle (ID); 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

401K match up to 5%

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus

Job summary

Navitus Health Solutions, LLC is hiring a Coordinator I, Provider Credentials to drive credentialing for pharmacy providers. You will work with national databases, ensure documentation, and support compliance with URAC standards.

You will report to the Manager of Provider Services and collaborate with Pharmacy Relations Contract Analysts to maintain a qualified pharmacy network. Strong data-mining, analytical, and independent work skills are essential.

Qualifications

• High school diploma or equivalent required; advanced degree preferred.
• Experience analyzing medical/pharmacy claims or credentials is valued.
• Ability to work independently with strong verbal and written communication; manage multiple priorities.

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 reflect new statutes/regulations.
• Create reports of credential activity for department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data as needed.
• Assist in administering provider credentialing programs and resolving processing issues.
• Support obtaining attestations (Fraud, Waste, and Abuse) from providers as required.
• Update systems to reflect data from external databases; support network strategies.
• Other duties as assigned.

Skills

Telephonic skills

Written communication

Data mining

Analytical skills

Multitasking

Independent work

Microsoft Office

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 drive credentialing for pharmacy providers. You will work with national databases, ensure documentation, and support compliance with URAC standards.

You will report to the Manager of Provider Services and collaborate with Pharmacy Relations Contract Analysts to maintain a qualified pharmacy network. Strong data-mining, analytical, and independent work skills are essential.