Provider Credentials Coordinator (Remote)

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

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

9 holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional Membership assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role focuses on receiving, processing, and first-level evaluating provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

The coordinator ensures credentialing aligns with Navitus policies and URAC standards while supporting a qualified pharmacy network. The position reports to the Manager of Provider Services and collaborates with Pharmacy Relations Contract Analysts to

Qualifications

• High school or equivalent
• Retail pharmacy experience or managed care setting desired
• Experience analyzing medical/pharmacy claims or credentials
• Independent worker with strong communication, data-mining, and multitasking skills
• Professional interaction with providers at all levels

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials
• Ensure credentials are documented and file audits identify non-compliant documentation
• Support URAC compliance and enhance P&Ps to meet new statutes and guidance
• Create credential activity reports for department VP and Credential Committees
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data
• Assist Network Development in determining and implementing credentialing strategies
• Support annual Fraud, Waste, and Abuse attestations
• Update systems to reflect external database data
• Other duties as assigned

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role focuses on receiving, processing, and first-level evaluating provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

The coordinator ensures credentialing aligns with Navitus policies and URAC standards while supporting a qualified pharmacy network. The position reports to the Manager of Provider Services and collaborates with Pharmacy Relations Contract Analysts to