Remote Credentialing Coordinator, Provider Network

Navitus; Olympia (WA); À distance; USD 52 000 - 78 000; Plein temps

Avantages offerts par ce poste

Health, dental, and vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption assistance

Flexible Spending Account

Educational and professionalMembership

Referral bonus up to $750

Résumé du poste

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in a remote capacity. The role focuses on facilitating credentialing across internal and external providers, handling data from NCPDP, HMS, DEA, and state databases, and ensuring compliance with URAC standards.

Responsibilities include credential document management, reporting, and supporting related contracts and pricing questions.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care exposure desired.
• Experience analyzing medical/pharmacy claims or credentials desired.
• Ability to work independently with strong verbal and written communication; data-mine databases; analytical skills.
• Proficient in Microsoft applications; interact professionally with providers at all levels.

Responsabilités

• Daily communication with Navitus pharmacy providers and vendors to obtain, review and process credentials.
• Ensure credentials are documented in systems and retained in contract files; audit for non-compliance.
• Support compliance with URAC and Navitus policies; update policies for new statutes or regulations.
• Create reports on credential activity; report to department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data as needed.
• Assist Network Development in pharmacy network strategy development and implementation.
• Support annual attestations (Fraud, Waste, and Abuse) reporting from providers.
• Update systems to reflect data from external databases like NCPDP.
• Other duties as assigned by leadership.

Connaissances

Independent work

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Microsoft Office

Provider interaction

Formation

High School diploma or equivalent

Advanced degree preferred

Outils

MS Office

Description du poste

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in a remote capacity. The role focuses on facilitating credentialing across internal and external providers, handling data from NCPDP, HMS, DEA, and state databases, and ensuring compliance with URAC standards.

Responsibilities include credential document management, reporting, and supporting related contracts and pricing questions.