Remote Provider Credentialing Coordinator

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

Benefits offered by this job

Health insurance

Paid time off 20 days

Parental leave 4 weeks

9 paid holidays

401K company match

Adoption Assistance

Flexible Spending Account

Educational Assistance

Referral Bonus Program

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team in a role focused on credentialing of pharmacy providers and data management. The position involves processing credentials, ensuring compliance with federal and state regulations, and supporting the Pharmacy Relations team.

The ideal candidate has experience in pharmacy credentialing, strong communication skills, and the ability to manage multiple tasks while maintaining accuracy and compliance with

Qualifications

• High school diploma required; 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, strong telephonic and written communication, data mining, and multitasking across priorities.

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in contract files; audit for compliance.
• Support URAC and Navitus policies to maintain a qualifed pharmacy network and update procedures.
• Create reports of credential activity and present to VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data as needed.
• Assist in administering the Navitus pharmacy programs and resolving pricing questions or processing issues.
• Support attestations from providers and other required documentation.
• Update systems with data from external databases as appropriate.
• Assist in strategy discussions for pharmacy network development.
• Other duties as assigned.

Skills

Communication skills

Data mining

Analytical skills

Multitasking

Independent worker

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 join our team in a role focused on credentialing of pharmacy providers and data management. The position involves processing credentials, ensuring compliance with federal and state regulations, and supporting the Pharmacy Relations team.

The ideal candidate has experience in pharmacy credentialing, strong communication skills, and the ability to manage multiple tasks while maintaining accuracy and compliance with