Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Minneota (MN); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Holidays

401K company match

Adoption Assistance

Flexible Spending Account

Education assistance

Professional membership support

Referral bonus program

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role focuses on facilitating receipt, processing, first-level evaluation, and creation of internal and external credentialing reports for providers.

The Coordinator will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing aligns with Navitus policies and URAC standards, enabling qualified pharmacies and prescribers to participate in Navitus programs.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials desired.

Responsibilities

• Daily communication with Navitus pharmacy providers and strategic vendors to obtain, review, and process credentials.
• Ensure credentials are received, documented in systems, and retained in contract files; audit for non-compliance.
• Support compliance to URAC and Navitus policies; update procedures to meet new statutes or guidance.
• Create reports of credential activity; report to department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract information.
• Assist with administration of Navitus pharmacy programs and resolve pricing or processing issues.

Skills

Communication

Data mining

Analytical thinking

Multitasking

Education

High school diploma

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role focuses on facilitating receipt, processing, first-level evaluation, and creation of internal and external credentialing reports for providers.

The Coordinator will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing aligns with Navitus policies and URAC standards, enabling qualified pharmacies and prescribers to participate in Navitus programs.