Remote Provider Credentialing Coordinator I

Navitus; Nashville (TN); Remote; USD 45,000 - 60,000; Full time

Benefits offered by this job

Health, dental, vision insurance

Paid time off 20 days

Parental leave 4 weeks

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to manage credential receipts, processing, and initial evaluation for internal and external reports. You will liaise with NCPDP, HMS, DEA and state boards to ensure credentialing compliance across the network.

The role requires strong communication skills, attention to regulatory detail, and the ability to work with multiple databases and departments to maintain a qualified pharmacy network.

Qualifications

• Experience analyzing medical or pharmacy claims or credentials is highly desired.
• Retail pharmacy or managed care setting experience is a plus.
• Ability to work independently and manage multiple priorities with strong communication.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented in systems and retained in files; audit for non-compliant documentation.
• Support URAC compliance and update procedures to meet new regulations.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract information.
• Assist network teams with provider issues and pricing questions related to credentials.
• Support annual attestations and other compliance attestations as required.

Skills

Data mining

Analytical skills

Verbal & written communication

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 manage credential receipts, processing, and initial evaluation for internal and external reports. You will liaise with NCPDP, HMS, DEA and state boards to ensure credentialing compliance across the network.

The role requires strong communication skills, attention to regulatory detail, and the ability to work with multiple databases and departments to maintain a qualified pharmacy network.