Remote Pharmacy Credentialing Specialist

Navitus Health Solutions, LLC; Kentucky; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible spending account

Educational assistance

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 across internal and external databases, reporting to the Manager of Provider Services.

The role requires knowledge of pharmacy processing practices and regulatory requirements. You will support URAC compliance and ensure that credentialing meets Navitus policies while enabling qualified pharmacies to participate.

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Experience analyzing medical and/or pharmacy claims.
• Ability to work independently with strong communication and data skills.
• Proficient in Microsoft Office applications.
• Professional interaction with providers at all levels required.
• Able to collaborate with multiple departments.

Responsibilities

• Interact daily with Navitus pharmacy providers and vendors to obtain and review credentials.
• Ensure credentials are documented in appropriate systems and audited for compliance.
• Support URAC compliance and update policies to reflect new regulations.
• Create credential activity reports for leadership committees.
• Monitor credential databases such as HMS, NCPDP, OIG, DEA and State Boards.
• Assist in provider network administration and resolve pricing questions.
• Support attestations for Fraud, Waste, and Abuse and other requirements.
• Update systems with data from external databases as appropriate.
• Assist in network strategy determination and implementation.
• Other duties as assigned.

Skills

Retail pharmacy experience

Claims analysis

Independent worker

Microsoft Office

Provider interaction

Education

High school diploma

Tools

NCPDP system

HMS database

DEA databases

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 across internal and external databases, reporting to the Manager of Provider Services.

The role requires knowledge of pharmacy processing practices and regulatory requirements. You will support URAC compliance and ensure that credentialing meets Navitus policies while enabling qualified pharmacies to participate.