Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Arkansas City (KS); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Md

Professional Membership assistance

Referral Bonus Program – up to $750!

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and first level evaluation of provider credentials, ensuring accurate documentation and timely reporting to internal stakeholders.

The role requires interaction with NCPDP, HMS, DEA, State Boards of Pharmacy, and federal databases; you will audit credential packs, support URAC compliance, and help expand the credentialed provider network.

Qualifications

• Requires good communication, both telephonic and written.
• Analytical skills and ability to work with multiple databases.
• Experience analyzing medical/pharmacy claims or credentials desired.
• Ability to work independently and manage multiple priorities while coordinating with internal/external providers.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensures credentials are received and documented in systems; audits for non-compliant documentation.
• Supports URAC compliance and updates policies to reflect new regulations.
• Create reports of credential activity and present findings to managers/committees.
• Monitor credential data in HMS, NCPDP, OIG, DEA and State Boards; pull insights as needed.
• Assist Pharmacy Network in pricing questions and processing requirements.
• Obtain and report annual Fraud, Waste, and Abuse attestations and other attestations as required.
• Update systems to reflect data from external databases.
• Assist in evaluating and implementing pharmacy network strategies.
• Other duties as assigned.

Skills

Communication skills

Analytical skills

Data mining

Time management

Education

High school or equivalent

Tools

Microsoft applications

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and first level evaluation of provider credentials, ensuring accurate documentation and timely reporting to internal stakeholders.

The role requires interaction with NCPDP, HMS, DEA, State Boards of Pharmacy, and federal databases; you will audit credential packs, support URAC compliance, and help expand the credentialed provider network.