Provider Credentials Coordinator – Remote (US)

Navitus Health Solutions, LLC; Tennessee; On-site; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K match 5%

Adoption assistance

FSA

Educational assistance & membership

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and first-level evaluation of provider credentials, working with NCPDP, HMS, DEA, and state boards to ensure compliant credentialing.

Reporting to the Manager of Provider Services, you will maintain credentialing files, generate reports for leadership, and support attestations and program updates to meet Navitus policies and URAC standards.

Qualifications

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

Responsibilities

• Communicate daily with Navitus providers to obtain, review, and process credentials.
• Ensure credentials are documented and audited for compliance.
• Support URAC compliance and update policies for new statutes or guidance.
• Create credential activity reports for VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and others.
• Assist in administration of Navitus pharmacy programs and pricing questions.
• Support annual Fraud, Waste, and Abuse attestations and other attestations.
• Update systems with data from external databases.
• Assist in determining and implementing pharmacy network strategies.
• Perform other duties as assigned.

Skills

Independent work

Telephonic communication

Written communication

Analytical skills

Multitasking

Provider interaction

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. You will facilitate receipt, processing, and first-level evaluation of provider credentials, working with NCPDP, HMS, DEA, and state boards to ensure compliant credentialing.

Reporting to the Manager of Provider Services, you will maintain credentialing files, generate reports for leadership, and support attestations and program updates to meet Navitus policies and URAC standards.