Remote Provider Credentialing Coordinator

Navitus; Tallahassee (FL); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave (4 weeks)

9 paid holidays

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program - up to 750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role is responsible for facilitating the receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials, working with NCPDP, HMS, DEA, state boards, and federal databases.

The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to ensure properly credentialed providers and adherence to Navitus

Qualifications

• High school or equivalent; advanced degree preferred.
• Experience in retail pharmacy or managed care setting desirable.
• Experience analyzing medical and/or pharmacy claims or credentials is highly desired.
• Ability to work independently, with telephonic and written communication skills, data-mine variable databases, and manage multiple priorities.
• Proficiency in Microsoft applications and understanding Navitus' policies and procedures.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are received, documented in systems, and retained in contract files; audit for compliance.
• Support URAC and Navitus policy compliance; update procedures to meet new statutes or guidance.
• Create credential activity reports; share with department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract information as needed.
• Assist in administration of Navitus pharmacy programs and resolve pricing or processing issues.
• Assist in obtaining attestations from providers, including fraud, waste and abuse.
• Update systems to reflect data from external databases (NCPDP, etc.).
• Support the development of network strategies and other duties as assigned.

Skills

Credential analysis

Verbal communication

Written communication

Independent work

Data mining

Multi-priority management

Microsoft Office

Education

High school or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role is responsible for facilitating the receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials, working with NCPDP, HMS, DEA, state boards, and federal databases.

The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to ensure properly credentialed providers and adherence to Navitus