Remote Provider Credentialing Coordinator

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

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

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 and Pro-Mc

Referral Bonus Program – up to $750

Descripción de la vacante

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role coordinates receipt, processing, and first-level evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing.

You will monitor credentialing activity, prepare reports for leadership, and support network strategy while ensuring adherence to Navitus policies and URAC standards.

Formación

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials.
• Able to work independently with strong communication, data mining, and analytical skills.
• Ability to interact professionally with providers at all levels.
• Proficient in Microsoft applications.
• Familiarity with Navitus policies and compliance objectives.
• Collaborate with other departments when needed.

Responsabilidades

• Daily communication with Navitus providers and vendors to obtain and process credentials.
• Ensure credentials are documented in systems and retained in files; audit for non-compliance.
• Support URAC compliance and update procedures to reflect new laws and guidance.
• Create reports on credential activity for VP and Credential Committees.
• Monitor data in credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist network development with credentialing strategy and pricing questions.
• Assist in obtaining annual Fraud, Waste, and Abuse attestations from providers.
• Update systems to reflect data from external databases.
• Other duties as assigned.

Conocimientos

Communication skills

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Provider interaction

Independent worker

Microsoft Office

Navitus policies

Educación

High school diploma or equivalent

Advanced degree preferred

Herramientas

Microsoft Office

Descripción del empleo

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role coordinates receipt, processing, and first-level evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing.

You will monitor credentialing activity, prepare reports for leadership, and support network strategy while ensuring adherence to Navitus policies and URAC standards.