Remote Provider Credentialing Coordinator I

Navitus Health Solutions, LLC; Montana; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

20 days PTO

Parental leave 4 weeks

9 paid holidays

401K with company match

Adoption assistance

Job summary

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to join our team in the United States. The role focuses on facilitating credential receipt, processing, and first-level evaluation, working with NCPDP, HMS, DEA, and state/federal databases to ensure compliant provider credentialing.

The coordinator will support Pharmacy Relations and contract analysts, ensuring all pharmacies and prescribers meet Navitus policies and URAC standards.

Qualifications

• High school or equivalent, advanced degree preferred.
• Retail pharmacy experience or experience in a managed care setting preferred.
• Experience analyzing medical and/or pharmacy claims or credentials is highly desirable.
• Ability to work independently with strong telephonic and written communication skills, data-mining, and analytical abilities.
• Professional interaction with providers at all levels is required.
• Proficiency in Microsoft applications and Navitus policies advised.

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensure credentials are recorded and retained in appropriate systems; audit for non-compliance.
• Support URAC compliance and Navitus policies; update procedures as statutes change.
• Create reports of credential activity for VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) for data accuracy.
• Assist in provider attestations and reporting requirements as needed.
• Update systems to reflect data from external databases and support network strategies.

Skills

Independent work

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to join our team in the United States. The role focuses on facilitating credential receipt, processing, and first-level evaluation, working with NCPDP, HMS, DEA, and state/federal databases to ensure compliant provider credentialing.

The coordinator will support Pharmacy Relations and contract analysts, ensuring all pharmacies and prescribers meet Navitus policies and URAC standards.