Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Salem (OR); 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 up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Mb

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role focuses on facilitating receipt, processing, 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 Contract Analysts to ensure credentialing aligns with regulations and Navitus policies. The position requires knowledge of pharmacy processing practices and strong communication

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials.
• Independent worker with telephonic and written communication, data mining, analytics, multitasking.
• Able to interact with providers at all levels.
• Can work independently while coordinating with other departments.
• Proficient in Microsoft applications.
• Familiar with Navitus policies and procedures.
• Support compliance program objectives.
• Collaborative and respectful team interaction.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendor(s) to obtain, review, and process credentials.
• Ensures credentials are received and documented in systems and retained in contract files; audit for compliance.
• Support URAC and Navitus policy to maintain a quality credentialed network; update policies as needed.
• Create reports of credential activity for VP and Credential Committees.
• Monitor and extract information from credential databases (NCPDP, HMS, OIG, DEA, State Boards).
• Assist in administration of Navitus pharmacy programs with providers and pricing questions.
• Support obtaining attestations from providers (Fraud, Waste, and Abuse).
• Update systems to reflect external database data (NCPDP, etc.).
• Assist in determining and implementing pharmacy network strategies.
• Other duties as assigned.

Skills

Communication skills

Data mining

Analytical skills

Microsoft Office

multitasking

Education

High school diploma

Advanced degree preferred

Tools

NCPDP databases

HMS system

DEA databases

State Boards of Pharmacy databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role focuses on facilitating receipt, processing, 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 Contract Analysts to ensure credentialing aligns with regulations and Navitus policies. The position requires knowledge of pharmacy processing practices and strong communication