Remote Provider Credentialing Coordinator

Navitus; Washington (District of Columbia); Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Paid time off 20 days

Paid parental leave 4 weeks

9 holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in a fully remote role. The coordinator will manage receipt, processing, and first-level evaluation of provider credentials, ensuring compliance with URAC standards and Navitus policies, and support related reporting and data integrity.

The ideal candidate will have strong communication, data-mining abilities, and experience with pharmacy processing practices.

Qualifications

• High school or equivalent; advanced degree preferred.
• Experience analyzing medical/pharmacy claims or credentials is a plus.
• Ability to work independently with strong communication and analytical skills.
• Proficiency in Microsoft applications and data mining from various databases.

Responsibilities

• Process and review pharmacy provider credentials and reports.
• Maintain credentialing data in systems and audit files for compliance.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards).
• Support provider program administration and resolve credentialing issues.

Skills

Telephonic communication

Written communication

Analytical skills

Independent work

Education

High school diploma

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in a fully remote role. The coordinator will manage receipt, processing, and first-level evaluation of provider credentials, ensuring compliance with URAC standards and Navitus policies, and support related reporting and data integrity.

The ideal candidate will have strong communication, data-mining abilities, and experience with pharmacy processing practices.