Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Baton Rouge (LA); Remote; USD 28.000 - 33.000; Vollzeit

Benefits dieser Stelle

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program

Zusammenfassung

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team and manage the receipt, processing, and initial evaluation of provider credentials. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing aligns with Navitus policies and URAC standards.

Reporting to the Manager of Provider Services, you will support Pharmacy Relations Contract Analysts and help deliver accurate credentialing data and reporting while maintaining compliance

Qualifikationen

• Minimum high school diploma; advanced degree preferred.
• Retail pharmacy experience or managed care setting desirable.
• Experience analyzing medical/pharmacy claims or credentials.
• Ability to work independently with strong telephonic and written communication skills.
• Ability to interact professionally with providers at all levels.
• Proficiency in Microsoft applications.
• Support compliance programs and maintain Navitus policies.

Aufgaben

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in contract files; audit for compliance.
• Support URAC and Navitus policies; update procedures for new statutes or guidance.
• Create credential activity reports for VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data.
• Assist Network Development in pharmacy network strategy development and implementation.
• Support annual Fraud, Waste, and Abuse attestations from providers.
• Update systems with data from external databases as needed.
• Perform other duties as assigned.

Kenntnisse

Independent work

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Provider interactions

Interdepartmental collaboration

Ausbildung

High school or equivalent

Tools

Microsoft Office

Jobbeschreibung

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team and manage the receipt, processing, and initial evaluation of provider credentials. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing aligns with Navitus policies and URAC standards.

Reporting to the Manager of Provider Services, you will support Pharmacy Relations Contract Analysts and help deliver accurate credentialing data and reporting while maintaining compliance