Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Connecticut; A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

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

Referral Bonus Program – up to $750!

Descripción de la vacante

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate credential receipt, processing, first level evaluation, and reporting for internal and external credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services to ensure compliant credentialing. The role emphasizes adherence to Navitus policy, URAC standards, and maintaining a credentialed provider network while enabling

Formación

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials.
• Independent worker with strong communication, data mining and multitasking.
• Ability to interact professionally with providers at all levels.
• Proficient in Microsoft applications.

Responsabilidades

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensure credentials are documented and retained; audit for compliance.
• Support URAC policy compliance and update procedures as statutes/guidance change.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist Pharmacy Network in pricing questions and processing requirements.
• Support annual fraud, waste, and abuse attestations.
• Update systems with external database data as appropriate.
• Assist VP and network staff in credentialing network strategies.
• Other duties as assigned.

Conocimientos

Independent worker

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Provider interaction

Educación

High school diploma or equivalent

Advanced degree preferred

Herramientas

Microsoft Office

Descripción del empleo

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate credential receipt, processing, first level evaluation, and reporting for internal and external credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services to ensure compliant credentialing. The role emphasizes adherence to Navitus policy, URAC standards, and maintaining a credentialed provider network while enabling