Remote Provider Credentialing Coordinator

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

Benefits offered by this job

Health, dental and vision 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/M-

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions, LLC is hiring a Coordinator I, Provider Credentials to manage the credentialing inflow, processing, and first-level evaluation for internal and external reports. You’ll interact with NCPDP, HMS, DEA, and state/federal databases to ensure compliant provider credentials across Navitus’ network.

You will collaborate with Pharmacy Relations Contract Analysts and report to the Manager of Provider Services, maintaining data integrity and supporting compliance with policies

Qualifications

• High school diploma or equivalent required; advanced degree preferred.
• Retail pharmacy or managed care exposure desirable.
• Experience analyzing medical/pharmacy claims or credentials is a strong plus.
• Ability to work independently with telephonic and written communication skills.
• Proficiency in Microsoft Office applications essential.

Responsibilities

• Communicate with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and files; audit for compliance.
• Support URAC compliance and Navitus policies, updating procedures as statutes change.
• Create reports on credential activity and submit to leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, state boards) and extract data as needed.
• Assist network team in administration of Navitus pharmacy programs and pricing questions.
• Support annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems to reflect external database data accurately.
• Assist leadership in evaluating and implementing network strategies.
• Perform other duties as assigned.

Skills

Independent work

Communication skills

Data analysis

Multitasking

Microsoft Office

Education

High school diploma or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA databases

Job description

Navitus Health Solutions, LLC is hiring a Coordinator I, Provider Credentials to manage the credentialing inflow, processing, and first-level evaluation for internal and external reports. You’ll interact with NCPDP, HMS, DEA, and state/federal databases to ensure compliant provider credentials across Navitus’ network.

You will collaborate with Pharmacy Relations Contract Analysts and report to the Manager of Provider Services, maintaining data integrity and supporting compliance with policies