Remote Pharmacy Provider Credentialing Coordinator

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

Benefits offered by this job

Health insurance (medical)

PTO 20 days

Parental leave

9 paid holidays

401K company match

Adoption assistance

Flexible Spending Account

Educational support

Referral bonus program

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The Coordinator I, Provider Credentials facilitates receipt, processing, first level evaluation, and creation of internal and external credential reports, working with NCPDP, HMS, DEA, state and federal databases.

You will report to the Manager of Provider Services and support Navitus' contracting teams. Responsibilities include credential data management, compliance with URAC standards, and preparing

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Experience analyzing medical/pharmacy claims or credentials is desirable.
• Able to work independently with strong verbal and written communication.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensures credentials are documented in systems and retained in contract files; audits for compliance.
• Supports URAC compliance and policy updates; enriches procedures to meet new statutes.
• Creates credential activity reports; communicates findings to VP and Credential Committees.
• Monitors databases (HMS, NCPDP, OIG, DEA, State Boards) for credential data.

Skills

Independent work

Telephonic communication

Written communication

Data mining

Analytical skills

Multi-tasking

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The Coordinator I, Provider Credentials facilitates receipt, processing, first level evaluation, and creation of internal and external credential reports, working with NCPDP, HMS, DEA, state and federal databases.

You will report to the Manager of Provider Services and support Navitus' contracting teams. Responsibilities include credential data management, compliance with URAC standards, and preparing