Remote Provider Credentialing Coordinator

Navitus; Dover (DE); Remote; USD 55,000 - 70,000; 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 Member

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role manages receipt, processing, and first-level evaluation of provider credentials, coordinating with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing of pharmacies and prescribers.

The position reports to the Manager of Provider Services and supports contract analysts. Candidates should have strong communication, data mining, and analytical skills to maintain Navitus’

Qualifications

• High school or equivalent, advanced degree preferred.
• Retail pharmacy experience or experience in a managed care pharmacy setting desired.
• Prior experience analyzing medical and/or pharmacy claims or credentials highly desired.
• Independent work capability with telephonic and written communication, data mining, and analytical skills.
• Ability to interact with providers at all levels (internal and external).
• Must function independently, with collaboration across departments.
• Proficient in Microsoft applications.
• Knowledge of Navitus’ business concepts, practices, and policies and procedures.
• Participate in, adhere to, and support compliance program objectives.
• Ability to interact cooperatively with other employees.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are received and documented in systems; audit files for non-compliance.
• Support URAC compliance and Navitus policies; update policies or procedures as regulations change.
• Create reports of credential activity; submit to department VP and Credential Committees.
• Monitor and extract data from credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist Network Development in evaluating and implementing pharmacy network strategies.
• Support obtaining annual Fraud, Waste, and Abuse attestations from providers.
• Update systems to reflect data consistent with external databases.
• Assist VP and Network Development in strategic planning for network expansion.
• Other duties as assigned.

Skills

Independent worker

Communication skills

Analytical skills

Multi-tasking

Interpersonal skills

Education

High school or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role manages receipt, processing, and first-level evaluation of provider credentials, coordinating with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing of pharmacies and prescribers.

The position reports to the Manager of Provider Services and supports contract analysts. Candidates should have strong communication, data mining, and analytical skills to maintain Navitus’