Remote Provider Credentialing Coordinator I

Navitus Health Solutions, LLC; Clifton (TX); A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Top industry benefits

Paid time off and parental leave

Descripción de la vacante

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. This role facilitates receipt, processing, first-level evaluation, and reporting of provider credentials with systems like NCPDP, HMS, DEA, and state boards.

The Coordinator reports to the Manager of Provider Services and supports Credential Committees to ensure all credentials meet Navitus policies and applicable regulations. A strong emphasis on data handling and regulatory compliance is required.

Formación

• 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 strong communication and multitasking skills.

Responsabilidades

• Daily communication with providers to obtain, review, and process credentials.
• Document credentials in systems and audit for non-compliance.
• Support URAC compliance and policies to ensure a quality network.
• Create credential activity reports for leadership and committees.
• Monitor credential databases and extract relevant information.
• Assist with provider attestations and data updates across systems.
• Support network development in credentialing strategy.

Conocimientos

Independent work

Telephonic & written communication

Data mining

Analytical skills

Multi-priority management

Professional interaction

Educación

High school diploma

Advanced degree preferred

Herramientas

Microsoft Office

NCPDP/HMS databases

DEA/state boards databases

Descripción del empleo

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. This role facilitates receipt, processing, first-level evaluation, and reporting of provider credentials with systems like NCPDP, HMS, DEA, and state boards.

The Coordinator reports to the Manager of Provider Services and supports Credential Committees to ensure all credentials meet Navitus policies and applicable regulations. A strong emphasis on data handling and regulatory compliance is required.