Remote Provider Credentialing Coordinator

Navitus; Salt Lake City (UT); Remote; USD 50,000 - 65,000; 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

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to drive credentialing for pharmacy providers. You will process first-level evaluations, manage data across NCPDP, HMS, DEA, and state databases, and ensure compliance with Navitus policies and URAC standards.

You will support reporting to VP and Committees, and collaborate with Pharmacy Relations teams to resolve pricing and processing questions while maintaining data integrity.

Qualifications

• High school or equivalent, advanced degree preferred.
• Retail or managed care pharmacy experience desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desired.
• Ability to work independently with strong telephonic and written communication.
• Proficient in Microsoft applications.
• Strong interpersonal skills with providers at all levels.
• Ability to manage multiple priorities and data-mine databases.
• Familiarity with Navitus policies and procedures.

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 files to identify non-compliant documentation and support URAC policies.
• Create reports of credential activity and present to VP and Committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards) for data accuracy.
• Assist Network Development in determining pharmacy network strategies.
• Support attaining attestations from providers and other required attestations.

Skills

Analytical skills

Telephonic communication

Written communication

Data mining

Provider interaction

Microsoft Office

Education

High school diploma or equivalent

Tools

NCPDP system

HMS system

DEA databases

State Boards of Pharmacy

Job description

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to drive credentialing for pharmacy providers. You will process first-level evaluations, manage data across NCPDP, HMS, DEA, and state databases, and ensure compliance with Navitus policies and URAC standards.

You will support reporting to VP and Committees, and collaborate with Pharmacy Relations teams to resolve pricing and processing questions while maintaining data integrity.