Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; El Paso (TX); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Paid time off 20 days

Parental leave 4 weeks

Holidays 9 days

401K matching up to 5%

Adoption assistance

Flexible Spending Account

Educational & Membership assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role manages the receipt, processing, and reporting of provider credentials, coordinating with NCPDP, HMS, DEA, and state boards to ensure qualified pharmacies participate and qualified prescribers process claims.

You'll work with the Manager of Provider Services and support Pharmacy Relations Contract Analysts, uphold URAC standards, and help maintain an accurate credentialed network while

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail or managed care pharmacy experience desirable.
• Experience analyzing medical/pharmacy claims or credentials desired.
• Ability to work independently, communicate clearly, and manage multiple priorities.
• Proficiency in Microsoft applications.
• Ability to interact professionally with providers at all levels.

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Audit files to ensure documentation compliance and quality credentialed network.
• Create reports of credential activity and issues.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards) and extract data.
• Support resolving pricing questions and processing requirements with providers.
• Assist in obtaining attestations from providers and maintain data in external databases.

Skills

Telephonic communication

Written communication

Independent work

Data mining

Analytical skills

Multiple priorities

Professional interaction withproviders

Microsoft applications

Education

High school diploma or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA

State Boards of Pharmacy

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role manages the receipt, processing, and reporting of provider credentials, coordinating with NCPDP, HMS, DEA, and state boards to ensure qualified pharmacies participate and qualified prescribers process claims.

You'll work with the Manager of Provider Services and support Pharmacy Relations Contract Analysts, uphold URAC standards, and help maintain an accurate credentialed network while