Remote Pharmacy Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Illinois; Hybrid; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health, Dental & Vision

PTO 20 days

Parental leave

Paid holidays

401K match

Adoption assistance

FSAs

Educational assistance

Professional membership

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in Illinois. The Coordinator facilitates receipt, processing, first-level evaluation, and creation of internal and external credential reports.

You will work with NCPDP, HMS, DEA, and state/federal databases to ensure provider credentials comply with regulations and Navitus policies. The role requires knowledge of pharmacy processing practices, regulations, and strong verbal/written communication.

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Experience analyzing medical or pharmacy claims or credentials highly desired.
• Able to work independently with strong communication, data-mine databases, and manage multiple priorities.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensures credentials are documented in systems and audited for compliance.
• Supports URAC compliance and Navitus policy to maintain a quality credentialed network.
• Create reports of credential activity for VP and Credential Committees.
• Monitors credential databases such as HMS, NCPDP, OIG, DEA, State Boards of Pharmacy.
• Assist Pharmacy Network in administration of Navitus programs and resolve pricing questions.
• Supports attestations and other compliance reporting as required.
• Update systems to reflect data from external databases.
• Assist leadership with network strategy development.
• Other duties as assigned.

Skills

Phone and written communication

Data mining

Independent worker

Education

High school diploma or equivalent

Tools

NCPDP

HMS

DEA databases

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in Illinois. The Coordinator facilitates receipt, processing, first-level evaluation, and creation of internal and external credential reports.

You will work with NCPDP, HMS, DEA, and state/federal databases to ensure provider credentials comply with regulations and Navitus policies. The role requires knowledge of pharmacy processing practices, regulations, and strong verbal/written communication.