Remote Pharmacy Credentialing Coordinator

Navitus Health Solutions, LLC; Vermont; 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 up to 5%

Adoption Assistance Program

Educational Assistance Plan

Referral Bonus Program—up to $750

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and first-level evaluation of provider credentials across NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support Pharmacy Relations Contract Analysts to ensure credentialing aligns with federal and state regulations and Navitus policies.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting preferred.
• Experience analyzing medical or pharmacy claims or credentials is highly desirable.
• Ability to work independently with telephonic and written communication, data-mine databases, analytical skills, and multi-tasking.
• Ability to interact professionally with providers at all levels.
• Proficiency in Microsoft applications.

Responsibilities

• Daily communication with Navitus pharmacy providers and strategic vendors to obtain, review, and process credentials.
• Ensures credentials are documented in systems and retained in contract files; audits for non-compliant documentation.
• Support URAC compliance and Navitus policies to maintain a quality credentialed pharmacy network; update SOPs as needed.
• Create reports of credential activity and present to department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract relevant data.
• Assist Network Development in determining and implementing pharmacy network strategies.
• Support annual Fraud, Waste, and Abuse attestations from providers.

Skills

Communication skills

Analytical skills

Data mining

Time management

Microsoft Office

Education

High school or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA

State Boards of Pharmacy

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and first-level evaluation of provider credentials across NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support Pharmacy Relations Contract Analysts to ensure credentialing aligns with federal and state regulations and Navitus policies.