Remote Pharmacy Provider Credentialing Coordinator I

Navitus; Lansing (MI); Remote; USD 52,000 - 68,000; Full time

Benefits offered by this job

Health insurance

PTO 20 days

Parental leave 4 weeks

9 holidays

401K match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance

Referral Bonus Program

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team as a remote professional in the United States. You will facilitate credential receipt, processing and first-level evaluation, working with NCPDP, HMS, DEA, and state/federal databases to ensure qualified providers participate in Navitus programs.

You will create credential reports, monitor databases, and support compliance with URAC standards while collaborating with the Manager of Provider Services and

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care pharmacy experience desired.
• Experience analyzing medical/pharmacy claims or credentials desired.
• Ability to work independently with telephonic and written communication, analyze databases, and manage multiple priorities.
• Proficiency in Microsoft applications; professional interaction with providers at all levels.
• Support compliance program objectives and Navitus policies.

Responsibilities

• Daily communication with Navitus providers and vendors to obtain/process credentials.
• Ensure credentials are documented in systems and audited for compliance.
• Support URAC and Navitus policies; update procedures for new statutes/regulations.
• Create reports of credential activity and present to VP and Committees.
• Monitor credential databases such as HMS, NCPDP, OIG, DEA, and State Boards.
• Assist Pharmacy Network in program administration and pricing inquiries.
• Assist in obtaining attestations including Fraud, Waste, and Abuse.
• Update systems to reflect external database data; aid network strategy reviews.
• Other duties as assigned.

Skills

Microsoft applications

Data mining

Verbal communication

Written communication

Analytical skills

Education

High school or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team as a remote professional in the United States. You will facilitate credential receipt, processing and first-level evaluation, working with NCPDP, HMS, DEA, and state/federal databases to ensure qualified providers participate in Navitus programs.

You will create credential reports, monitor databases, and support compliance with URAC standards while collaborating with the Manager of Provider Services and