Provider Credentialing Specialist (Remote)

Navitus Health Solutions, LLC; Pennsylvania; 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 paid holidays

401K company match up to 5%

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating credentialing processes, coordinating with NCPDP, HMS, DEA, and state/federal databases, and ensuring compliance with Navitus policies and URAC standards.

Responsibilities include daily provider communications, documentation in systems, and reporting credential activity to leadership. Remote-friendly US-wide role with a strong emphasis on accuracy and regulatory adherence.

Qualifications

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

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 non-compliant documentation.
• Support URAC compliance and Navitus policies; update procedures to meet new statutes or guidance.
• Create reports on credential activity and present to department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract information.

Skills

Communication skills

Independent worker

Data mining

Prior healthcare claims analysis

Microsoft applications

Education

High school diploma

Advanced degree preferred

Tools

NCPDP

HMS

DEA databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating credentialing processes, coordinating with NCPDP, HMS, DEA, and state/federal databases, and ensuring compliance with Navitus policies and URAC standards.

Responsibilities include daily provider communications, documentation in systems, and reporting credential activity to leadership. Remote-friendly US-wide role with a strong emphasis on accuracy and regulatory adherence.