Provider Credentials Specialist - Remote

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

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/M.

Referral Bonus Program – up to $750!

Job summary

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

The Coordinator I will work with NCPDP, HMS, DEA, States\’ provider databases, and Federal databases. You will report to the Manager of Provider Services and help ensure that all pharmacy providers are credentialed according to federal and state

Qualifications

• High school diploma 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 written and oral communication.
• Proficient with Microsoft applications and data mining databases.
• Able to interact professionally with providers at all levels.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain and process credentials.
• Ensures that credentials are documented in systems and retained; audits for compliance.
• Supports URAC compliance and Navitus policies; updates procedures as statutes change.
• Create reports of credential activity; present to VP and Credential Committees.
• Monitors credential databases (NCPDP, HMS, DEA, State Boards).
• Assist Network Development in pharmacy network strategies.
• Other duties as assigned.

Skills

Telephonic communication

Data analysis

Microsoft Office

Independent work

Provider interaction

Education

High school diploma

Advanced degree preferred

Tools

NCPDP systems

HMS

DEA databases

State boards databases

Job description

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

The Coordinator I will work with NCPDP, HMS, DEA, States\’ provider databases, and Federal databases. You will report to the Manager of Provider Services and help ensure that all pharmacy providers are credentialed according to federal and state