Remote Provider Credentialing Coordinator I

Navitus Health Solutions, LLC; Montana City (MT); A distancia; USD 28.000 - 33.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

20 days PTO

Parental leave

401K match

Descripción de la vacante

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

This role ensures credentialing meets Navitus policies and URAC standards, preventing non-qualified providers from participating in claims. The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to credential

Formación

• High school or equivalent; advanced degree preferred.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials.
• Ability to work independently with telephonic and written communication, multitasking.
• Proficient in Microsoft applications.
• Familiar with Navitus policies and business concepts.

Responsabilidades

• Daily communication with Navitus pharmacy providers and strategic vendor(s) to obtain, review, and process credentials.
• Ensures credentials are received, documented in systems, and retained in files; audits for non-compliance.
• Support URAC compliance and Navitus policies; update procedures as statutes or guidance change.
• Create credential activity reports for department leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards) and extract data as needed.
• Assist Pharmacy Network in pricing questions, processing requirements, and issue resolution.
• Support annual Fraud, Waste, and Abuse attestations and other required attestations.
• Update systems to reflect data consistent with external databases.
• Assist VP and Network Development in evaluating network strategies.
• Perform other duties as assigned.

Conocimientos

Analytical skills

Communication skills

Microsoft Office

Independent work

Educación

High school or equivalent, advanced degree preferred

Herramientas

NCPDP

HMS

DEA databases

Descripción del empleo

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, and evaluation of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

This role ensures credentialing meets Navitus policies and URAC standards, preventing non-qualified providers from participating in claims. The position reports to the Manager of Provider Services and supports Pharmacy Relations Contract Analysts to credential