Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Maryland; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K match up to 5%

Adoption assistance

FSA

Educational assistance

Professional membership assistance

Referral bonus up to $750

Job summary

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

You will report to the Manager of Provider Services and support Pharmacy Relations analysts to ensure all providers are properly credentialed per regulations. Strong communication and data management are essential.

Qualifications

• High school or equivalent, advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desired.
• Ability to work independently with telephonic and written communication skills.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain and process credentials.
• Ensure credentials are documented in systems and retained in files; audit for compliance.
• Support URAC compliance and Navitus policy; update procedures to meet new regulations.
• Create reports of credential activity for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) for data consistency.
• Assist in vendor communications and credentialing strategy development.
• Support annual attestations (Fraud, Waste, Abuse) and other required attestations.
• Update systems to reflect external database data.
• Collaborate with Network Development to review and implement credentialing strategies.
• Perform other duties as assigned.

Skills

Independent work

Phone & written communication

Data mining

Analytical skills

Multitasking

Education

High school diploma

Advanced degree preferred

Tools

NCPDP

HMS

DEA

Pharmacy databases

Job description

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

You will report to the Manager of Provider Services and support Pharmacy Relations analysts to ensure all providers are properly credentialed per regulations. Strong communication and data management are essential.