Remote Provider Credentialing Coordinator

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

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and evaluation of provider credentials while ensuring compliance with URAC and Navitus policies.

You will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing meets regulatory standards and supports a qualified pharmacy network.

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care pharmacy experience is desirable.
• Experience analyzing medical or pharmacy claims or credentials is highly desired.
• Ability to work independently with telephonic and written communication; manage multiple priorities.
• Proficient in Microsoft Office applications.
• Ability to interact professionally with providers at all levels.

Responsibilities

• Daily communication with Navitus providers to obtain, review, and process credentials.
• Ensure credentials are documented in appropriate systems and audited for non-compliance.
• Support URAC compliance and Navitus policy updates for credentialing.
• Create reports of credential activity for leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards).
• Assist Network personnel with credentialing-related pricing questions or issues.
• Assist in annual Fraud, Waste, and Abuse attestations.
• Update systems to reflect data from external databases.
• Assist in determination and implementation of pharmacy network strategies.
• Other duties as assigned.

Skills

Communication skills

Independent worker

Microsoft Office

Education

High school diploma or equivalent

Tools

NCPDP

HMS

DEA databases

State Boards of Pharmacy databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, and evaluation of provider credentials while ensuring compliance with URAC and Navitus policies.

You will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing meets regulatory standards and supports a qualified pharmacy network.