Provider Credentials Coordinator – Remote

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

Benefits offered by this job

Health, Dental & Vision insurance

PTO 20 days

Parental leave 4 weeks

9 paid holidays

401K company match 5%

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus – up to $750

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

Reports to the Manager of Provider Services and supports policy compliance to maintain a qualified pharmacy network. Responsibilities include credentialing communications, documentation, data audits, and creating credential activity reports for

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical or pharmacy claims or credentials highly desired.
• Able to work independently with strong telephonic and written communication skills.
• Proficient in Microsoft Office applications.
• Ability to interact professionally with providers at all levels.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in files; audit for compliance.
• Support URAC compliance and update policies to reflect new statutes or guidance.
• Create reports of credential activity for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) for data accuracy.
• Assist in administration of Navitus pharmacy programs and resolve credentialing issues.
• Support annual attestations and other required attestations.
• Update systems to reflect data from external databases.
• Assist leadership in determining and implementing pharmacy network strategies.
• Perform other duties as assigned.

Skills

Pharmacy credentialing

Data analysis

Customer communication

Microsoft Office

Education

High school diploma or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA databases

State Boards databases

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

Reports to the Manager of Provider Services and supports policy compliance to maintain a qualified pharmacy network. Responsibilities include credentialing communications, documentation, data audits, and creating credential activity reports for