Remote Provider Credentialing Coordinator I

Navitus; Little Rock (AR); Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health, Dental, and 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/Mo

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in the United States. This role focuses on facilitating receipt, processing, and first level evaluation of provider credentials, coordinating with NCPDP, HMS, DEA, and State/Federal databases, and ensuring compliance with Navitus policies and URAC standards.

The Coordinator will report to the Manager of Provider Services and support Pharma Relations Contract Analysts to credential pharmacy providers and

Qualifications

• High school or equivalent, advanced degree preferred.
• Experience in retail or managed care pharmacy settings is desired.
• Experience analyzing medical/ pharmacy claims or credentials is highly desired.
• Ability to work independently with strong communication, data mining, and analytical skills.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in contract files; audit for non-compliance.
• Support URAC compliance and Navitus policies; update procedures for new laws or guidance.
• Create reports of credential activity for VP and Credential Committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards) and extract relevant data.
• Assist in administering Navitus pharmacy programs and resolve pricing questions.
• Support annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems to reflect external database data as appropriate.
• Assist in determining and implementing pharmacy network strategies.

Skills

Communication skills

Data mining

Analytical skills

Prioritization

Independent work

Interpersonal skills

Microsoft Office

Education

High school or equivalent

Advanced degree preferred

Tools

NCPDP

HMS

DEA database

State boards databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team in the United States. This role focuses on facilitating receipt, processing, and first level evaluation of provider credentials, coordinating with NCPDP, HMS, DEA, and State/Federal databases, and ensuring compliance with Navitus policies and URAC standards.

The Coordinator will report to the Manager of Provider Services and support Pharma Relations Contract Analysts to credential pharmacy providers and