Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; United States; A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance and memberships

Referral bonus

Descripción de la vacante

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, initial evaluation, and reporting of provider credentials with databases like NCPDP, HMS, DEA, and state boards.

You'll report to the Manager of Provider Services and collaborate with Pharmacy Relations Contract Analysts to ensure credentialed providers meet federal and state regulations and Navitus policies.

Formación

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience.
• Experience analyzing medical/pharmacy claims or credentials.
• Ability to work independently with telephonic and written communication; manage multiple priorities.
• Proficient in Microsoft Office applications.

Responsabilidades

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are received, documented, and archived; audit for compliance.
• Support URAC and Navitus policies to maintain a qualified pharmacy network.
• Create reports of credential activity; provide to department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards, etc.).
• Assist in administering Navitus pharmacy programs and pricing questions with providers.
• Assist in obtaining attestations (Fraud, Waste, and Abuse) from providers.
• Update systems to reflect external database data; support network strategies.
• Other duties as assigned.

Conocimientos

Communication skills

Independent work style

Verbal and written communication

Data mining & analytics

Educación

High school diploma or equivalent

Advanced degree preferred

Experience in pharmacy/managed care setting

Herramientas

Microsoft Office

Descripción del empleo

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating receipt, processing, initial evaluation, and reporting of provider credentials with databases like NCPDP, HMS, DEA, and state boards.

You'll report to the Manager of Provider Services and collaborate with Pharmacy Relations Contract Analysts to ensure credentialed providers meet federal and state regulations and Navitus policies.