Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Oklahoma; Remote; 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

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Mb

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role involves facilitating receipt, processing, first-level evaluation, and reporting of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support the Credential Committees to ensure credentialing compliance. The position emphasizes understanding pharmacy processing practices and regulations, with strong

Qualifications

• ,

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensures credentials are documented in systems and retained in contract files; audits for non-compliant documentation.
• Support URAC compliance and Navitus policies; update procedures to meet new statutes or guidance.
• Create credential activity reports for department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract information.
• Assist in administration of Navitus pharmacy programs; resolve pricing questions and processing issues.
• Obtain and report annual Fraud, Waste, and Abuse attestations from providers.
• Update systems to reflect external databases such as NCPDP as appropriate.
• Assist in determining and implementing pharmacy network strategies.
• Other duties as assigned

Skills

Independent work

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Provider interaction

Education

High school or equivalent

Tools

Microsoft Office

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. The role involves facilitating receipt, processing, first-level evaluation, and reporting of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support the Credential Committees to ensure credentialing compliance. The position emphasizes understanding pharmacy processing practices and regulations, with strong