Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Minnesota; On-site; USD 28,000 - 33,000; 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

Professional Membership assistance

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to facilitate receipt, processing, and first level evaluation of provider credentials. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure qualified pharmacies participate and that credentials comply with Navitus policies and URAC standards.

The role requires strong verbal and written communication, data mining skills, and the ability to manage multiple priorities in a regulated environment.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Experience analyzing medical and/or pharmacy claims or credentials highly desired.
• Able to work independently with telephonic and written communication, data mining, and multitasking.
• Professional interaction with providers at all levels required.
• Proficient in Microsoft applications and Navitus policies.
• Participate in compliance goals and collaborate with other departments.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and audited for compliance.
• Support URAC compliance and update policies to meet statutes and guidance.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards).
• Assist network personnel with pricing questions and processing requirements.
• Support annual Fraud, Waste, and Abuse attestations and other attestations.
• Update systems to reflect data from external databases.
• Assist VP and Network Development in strategy implementation.
• Perform other duties as assigned.

Skills

Communication skills

Data mining

Analytical skills

Multitasking

Independent work

Microsoft Office

Education

High school diploma

Advanced degree preferred

Tools

NCPDP

HMS

DEA

State Boards of Pharmacy

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to facilitate receipt, processing, and first level evaluation of provider credentials. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure qualified pharmacies participate and that credentials comply with Navitus policies and URAC standards.

The role requires strong verbal and written communication, data mining skills, and the ability to manage multiple priorities in a regulated environment.