Provider Credentials Coordinator — Remote

Navitus Health Solutions, LLC; Williamstown (NJ); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Paid holidays

401K company match

Adoption Assistance

Flexible Spending Account

Education assistance

Referral bonus program

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 works with NCPDP, HMS, DEA, State Boards of Pharmacy, and Federal databases; reports to the Manager of Provider Services.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials a plus.
• Ability to work independently with strong verbal/written communication.
• Professional interaction with providers at all levels required.
• Proficient in Microsoft applications; knowledge of Navitus policies helpful.

Responsibilities

• Daily communication with Navitus providers and vendors to obtain and process credentials.
• Ensure credentials are documented in systems and retained in files; audit for non-compliance.
• Support URAC compliance and Navitus policy updates; adapt procedures as statutes change.
• Create credential activity reports; present to VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards, etc.).
• Support network program administration and processing requirements with providers.
• Assist in annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems with data consistent with external databases; assist in strategy reviews.
• Help determine and implement pharmacy network strategies; other duties as assigned.

Skills

Independent work

Telephonic communication

Data mining

Multitasking

Provider interaction

Microsoft Office

Education

High school or equivalent

Advanced degree preferred

Tools

Microsoft applications

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 works with NCPDP, HMS, DEA, State Boards of Pharmacy, and Federal databases; reports to the Manager of Provider Services.