Remote Credentialing Coordinator Provider Network

Navitus Health Solutions, LLC; Alton (IL); A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

20 days PTO

4 weeks parental leave

9 holidays

401K company match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance Plan and Pro/M

Referral Bonus Program – up to $750

Descripción de la vacante

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating credential receipt, processing, first-level evaluation, and reporting for pharmacy providers.

You will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing meets Navitus policies and URAC standards. You will collaborate with Pharmacy Relations and contract analysts to maintain a qualified provider network, manage credentialing documentation,

Formación

• High school or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting experience desired.
• Experience analyzing medical and/or pharmacy claims or credentials.
• Ability to work independently with telephonic and written communication, data-mine databases, and multitask across priorities.
• Proficiency in Microsoft applications.

Responsabilidades

• Daily communication with Navitus pharmacy providers and strategic vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in contract files; audit for non-compliant documentation.
• Support URAC and Navitus policies to maintain a qualified pharmacy network and update procedures with new regulations.
• Create reports of credential activity and present findings to leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract relevant data.
• Assist in administering the Navitus pharmacy programs and resolve pricing or processing issues with providers.
• Support annual Fraud, Waste, and Abuse attestations from providers and other required attestations.
• Update systems to reflect data consistent with external databases.
• Assist leadership in determining and implementing network strategies.
• Other duties as assigned.

Conocimientos

Independent work

Telephonic communication

Data mining

Analytical skills

Multitasking

Interpersonal skills

Verbal & written communication

Educación

High school

Herramientas

Microsoft Office

Descripción del empleo

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating credential receipt, processing, first-level evaluation, and reporting for pharmacy providers.

You will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing meets Navitus policies and URAC standards. You will collaborate with Pharmacy Relations and contract analysts to maintain a qualified provider network, manage credentialing documentation,