Remote Provider Credentialing Coordinator

Navitus; Denver (CO); Remote; USD 48,000 - 64,000; Full time

Benefits offered by this job

20 days PTO

Parental leave (4 weeks)

9 holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in a remote-capable role. You will facilitate receipt, processing, and first-level evaluation of provider credentials, coordinating with NCPDP, HMS, DEA, and State/Federal databases to ensure qualified pharmacies and prescribers.

The role reports to the Manager of Provider Services and supports Contract Analysts to maintain compliance with policies and URAC standards.

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials desired.
• Ability to work independently with strong telephonic and written communication, data-mining, and prioritization skills.
• Proficient in Microsoft applications and professional interaction with providers at all levels.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Maintain documentation of credentials in appropriate systems and files; audit for non-compliant documentation.
• Support URAC compliance and Navitus policy updates; assist in updating policies to reflect new statutes or guidance.
• Create credential activity reports for VP and Credential Committees.
• Monitor and extract information from credential databases such as HMS, NCPDP, OIG, DEA, and State Boards.
• Assist in administration of Navitus pharmacy programs, resolving pricing questions and processing requirements with providers.
• Support annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems to reflect data from external databases (e.g., NCPDP).
• Assist in determining and implementing pharmacy network strategies with leadership.
• Other duties as assigned

Skills

Communication skills

Analytical skills

Data mining

Multitasking

Independent working

Education

High school diploma or equivalent

Bachelor’s degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in a remote-capable role. You will facilitate receipt, processing, and first-level evaluation of provider credentials, coordinating with NCPDP, HMS, DEA, and State/Federal databases to ensure qualified pharmacies and prescribers.

The role reports to the Manager of Provider Services and supports Contract Analysts to maintain compliance with policies and URAC standards.