Remote Pharmacy Provider Credentialing Specialist

Navitus; Frankfort (KY); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

Parental leave (4 weeks)

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro F2

Professional Membership assistance

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role facilitates the receipt, processing, evaluation, and reporting of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

Reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to ensure qualified providers and compliance with Navitus policies and URAC standards.

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.
• Ability to work independently, with telephonic and written communication skills, data-mine variable databases, and prioritize multiple tasks.
• Ability to interact with providers at all levels respectfully and professionally.
• Proficient in Microsoft applications.
• Familiarity with Navitus policies and procedures to achieve goals.
• Support compliance program objectives.

Responsibilities

• Communicate daily with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensure credentials are received, documented, and retained in files; audit for non-compliance.
• Support URAC and Navitus policies; update procedures as statutes or guidelines change.
• Create credential activity reports for department leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data.
• Assist Pharmacy Network in pricing questions and provider communications.
• Assist in obtaining attestations (Fraud, Waste, and Abuse) and other required attestations.
• Update systems to reflect external database data.
• Assist in development of network strategies with VP and colleagues.
• Perform other duties as assigned.

Skills

Communication skills

Analytical skills

Independent work capability

Multitasking

Interpersonal skills

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role facilitates the receipt, processing, evaluation, and reporting of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

Reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to ensure qualified providers and compliance with Navitus policies and URAC standards.