Provider Credentialing Specialist - Remote

Navitus Health Solutions, LLC; Louisiana; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance & Professional

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in the United States. The role focuses on credentialing providers, reviewing documentation, and creating reports while ensuring compliance with federal and state regulations.

The coordinator will work with databases like NCPDP, HMS, and DEA, reporting to the Manager of Provider Services and supporting contract analysts to credential providers accurately and timely.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail or managed care pharmacy experience desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desirable.
• Ability to work independently with good telephonic and written communication, data mining, and multitasking.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensures credentials are documented in systems and files; audits for non-compliance.
• Support URAC compliance and Navitus policies to maintain a qualified pharmacy network.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist in resolving pricing questions and processing requirements with network teams.
• Support attestations and other regulatory reporting as required.
• Update systems to reflect external database data accurately.
• Assist leadership in network strategy reviews and implementations.
• Perform other duties as assigned.

Skills

Independent work

Telephonic & written comms

Data mining

Analytical skills

Multi-tasking

Professional interaction withProviders

Education

High school 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 the United States. The role focuses on credentialing providers, reviewing documentation, and creating reports while ensuring compliance with federal and state regulations.

The coordinator will work with databases like NCPDP, HMS, and DEA, reporting to the Manager of Provider Services and supporting contract analysts to credential providers accurately and timely.