Remote Provider Credentialing Coordinator

Navitus Health Solutions, LLC; Wilmington (VT); À distance; USD 28 000 - 33 000; Plein temps

Avantages offerts par ce poste

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Holiday pay

401K match

Adoption Assistance

Flexible Spending Account

Educational Assistance

Professional Membership assistance

Referral Bonus Program

Résumé du poste

Navitus Health Solutions is hiring a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and first-level evaluation of provider credentials and generate internal and external reports.

The role involves working with NCPDP, HMS, DEA, and state/federal databases to ensure qualified pharmacies and providers participate in Navitus programs. The position reports to the Manager of Provider Services and supports Contract Analysts to ensure credentialing aligns

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desired.
• Ability to work independently with telephonic and written communication, data mining, and prioritization skills.
• Proficiency in Microsoft applications and professional interaction with providers.

Responsabilités

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensures credentials are documented and audited for compliance.
• Support URAC compliance and update policies to meet new statutes/regulations.
• Create credential activity reports for VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist in administration of Navitus pharmacy programs and resolve pricing questions.
• Support annual Fraud, Waste, and Abuse attestations.
• Update systems to reflect external database data.

Connaissances

Communication

Analytical skills

Data mining

Independent work

Multitasking

Formation

High school diploma or equivalent

Outils

Microsoft Office

Description du poste

Navitus Health Solutions is hiring a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and first-level evaluation of provider credentials and generate internal and external reports.

The role involves working with NCPDP, HMS, DEA, and state/federal databases to ensure qualified pharmacies and providers participate in Navitus programs. The position reports to the Manager of Provider Services and supports Contract Analysts to ensure credentialing aligns