Remote Provider Credentialing Coordinator

Navitus; Des Moines (IA); Remote; USD 42,000 - 56,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible spending account

Educational assistance

Referral bonus

Job summary

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to facilitate credentialing for internal and external providers. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing according to regulations and Navitus policies.

You will generate credential reports, maintain documentation, and support URAC standards while collaborating with Pharmacy Relations and Contract Analysts.

Qualifications

• High school or equivalent is required; advanced degree preferred.
• Retail pharmacy experience or managed care pharmacy setting is desirable.
• Experience analyzing medical or pharmacy claims or credentials is highly desired.
• Candidates should work well independently and manage multiple priorities with strong written and telephonic communication.
• Proficiency with Navitus policies and procedures and ability to interact professionally with providers at all levels.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are received, documented in systems, and retained in contract files; audit for non-compliant documentation.
• Support URAC compliance and update policies to meet statutes and guidance.
• Create reports of credential activity and submit to VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract information.
• Assist Network Development in pharmacy network strategies and processing requirements.
• Obtain annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems to reflect external database data (NCPDP, etc.).
• Support provider services in addressing pricing questions and processing issues.

Skills

Communication

Data mining

Analytical skills

Multitasking

Provider interaction

Education

High school or equivalent

Tools

Microsoft Office

Job description

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to facilitate credentialing for internal and external providers. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing according to regulations and Navitus policies.

You will generate credential reports, maintain documentation, and support URAC standards while collaborating with Pharmacy Relations and Contract Analysts.