Remote Provider Credentialing Coordinator I

Navitus; Austin (TX); Remote; USD 52,000 - 76,000; Full time

Benefits offered by this job

Health Insurance

Paid time off 20 days

Parental leave 4 weeks

9 paid holidays

401K company match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance

Referral Bonus up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to facilitate credentialing for internal and external providers. You will handle credential receipt, data entry, first-level evaluation, and reporting, working with NCPDP, HMS, DEA, and state/federal databases.

You will support the network with pricing questions, attestations, and data updates while ensuring compliance with Navitus policies and URAC standards. Strong communication and analytic skills are essential.

Qualifications

• High school diploma or equivalent required; advanced degree preferred.
• Experience in retail pharmacy or managed care setting desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desired.
• Ability to work independently, communicate effectively by phone and writing, and manage multiple priorities.
• Ability to interact professionally with providers at all levels.
• Proficiency in Microsoft applications.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain and process credentials.
• Ensure credentials are received, documented in appropriate systems, and audited for non-compliance.
• Support URAC compliance and update policies to reflect new statutes and guidance.
• Create credential activity reports for department VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data as needed.
• Assist Network Development in pharmacy network strategies and processing requirements.
• Support attestations (Fraud, Waste, and Abuse) collection from providers.
• Update systems to reflect data from external databases.
• Assist leadership in determining and implementing pharmacy network strategies.
• Perform other duties as assigned.

Skills

Communication skills

Analytical skills

Data mining

Independent work

Multitasking

Provider interaction

Microsoft Office

Compliance awareness

Team collaboration

Problem solving

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to facilitate credentialing for internal and external providers. You will handle credential receipt, data entry, first-level evaluation, and reporting, working with NCPDP, HMS, DEA, and state/federal databases.

You will support the network with pricing questions, attestations, and data updates while ensuring compliance with Navitus policies and URAC standards. Strong communication and analytic skills are essential.