Remote Provider Credentialing Coordinator I

Navitus Health Solutions, LLC; Nevada; A distancia; USD 28.000 - 33.000; Jornada completa

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Descripción de la vacante

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role manages credential receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials.

The Coordinator will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing complies with regulations and Navitus policies. This position supports Pharmacy Relations Contract Analysts and Navitus’ provider network strategies.

Formación

• High school or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Prior experience analyzing medical and/or pharmacy claims or credentials highly desired.
• Ideal candidate will be able to work independently with telephonic and written communication skills, data-mine variable databases, and manage multiple priorities.
• Ability to interact professionally with providers at all levels (internal and external).
• Must function independently but collaborate with other departments.
• Proficient in Microsoft applications and Navitus policies.

Responsabilidades

• Daily communication with Navitus providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented and retained in systems and audited for non-compliant documentation.
• Support URAC compliance and Navitus policies; update procedures for new statutes/regulations.
• Create credential activity reports for VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract data.
• Assist with administration of Navitus pharmacy programs and pricing questions.

Conocimientos

Independent work

Communication skills

Analytical skills

Data mining

Multitasking

Educación

High school or equivalent

Advanced degree preferred

Herramientas

Microsoft applications

Descripción del empleo

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role manages credential receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials.

The Coordinator will work with NCPDP, HMS, DEA, and state/federal databases to ensure credentialing complies with regulations and Navitus policies. This position supports Pharmacy Relations Contract Analysts and Navitus’ provider network strategies.