Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Clayton (MO); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

FSAs

Education assistance

Professional membership

Referral bonus

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, initial evaluation, and reporting of provider credentials, interacting with NCPDP, HMS, DEA, and state/federal databases.

The person will report to the Manager of Provider Services and support Credential Committees to ensure fully credentialed pharmacy providers.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care experience desired.
• Experience analyzing medical/pharmacy claims or credentials.

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain and process credentials.
• Ensure credentials are documented in systems and retained in files; audit non-compliant documentation.
• Support URAC compliance and update policies to reflect new statutes or guidance.
• Create credential activity reports for VP and Credential Committees.
• Monitor credential databases such as HMS, NCPDP, OIG, DEA, and State Boards.
• Assist with provider program administration and resolve pricing questions.
• Support annual fraud, waste and abuse attestations.
• Update systems to reflect data from external sources as needed.
• Help determine and implement pharmacy network strategies.
• Other duties as assigned.

Skills

Telephonic communication

Written communication

Analytical skills

Independent worker

Microsoft Office

Education

High school or equivalent

Advanced degree preferred

Tools

NCPDP systems

HMS

DEA databases

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, initial evaluation, and reporting of provider credentials, interacting with NCPDP, HMS, DEA, and state/federal databases.

The person will report to the Manager of Provider Services and support Credential Committees to ensure fully credentialed pharmacy providers.