Provider Credentials Coordinator - Remote

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

Benefits offered by this job

Health, Dental & Vision insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible Spending Account

Educational Assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The Coordinator I, Provider Credentials is responsible for facilitating the receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials.

The role interfaces with NCPDP, HMS, DEA, and state/federal databases to ensure compliance. The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to ensure all

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical and/or pharmacy claims or credentials is highly desired.
• Ability to work independently with telephonic and written communication, and to analyze data across multiple databases.
• Proficient in Microsoft Office applications.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensures that credentials are documented in systems and retained in contract files. Audits files or systems to identify non-compliant documentation.
• Supports compliance to URAC and Navitus’ policy and procedures to ensure a quality credentialed pharmacy network.
• Create reports of credential activity, including positive credentials, negative credentials, issues associated with credentials, etc.
• Monitors and extracts information from credential databases, such as HMS, NCPDP, OIG, DEA, State Boards of Pharmacy, and others as identified.
• Assist Pharmacy Network team in administration of Navitus pharmacy programs with providers and resolution of processing issues.
• Supports obtaining and reporting of annual Fraud, Waste, and Abuse attestations from providers.
• Updates systems to reflect data consistent with external databases, such as NCPDP.
• Assists VP and other Network Development associates in determination, review, and implementation of pharmacy network strategies.
• Other duties as assigned.

Skills

Independent worker

Telephonic communication

Data mining

Analytical skills

Prioritization

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The Coordinator I, Provider Credentials is responsible for facilitating the receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials.

The role interfaces with NCPDP, HMS, DEA, and state/federal databases to ensure compliance. The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to ensure all