Remote Provider Credentialing Coordinator I

Navitus; Saint Paul (MN); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

Health insurance

20 days PTO

4 weeks parental leave

9 holidays

401K company match (up to 5%)

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on receiving, processing, and first-level evaluating provider credentials, working with NCPDP, HMS, DEA, and state/Federal databases to ensure qualified pharmacy networks and compliant providers.

The candidate will report to the Manager of Provider Services and support contract analysts, ensuring credentialing aligns with Navitus policies and URAC standards while maintaining professional

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desirable.
• Prior experience analyzing medical and/or pharmacy claims or credentials is highly desired.
• Ability to work independently, with strong telephonic and written communication skills.
• Proficient in Microsoft applications and able to interact with providers at all levels.

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 compliance.
• Support URAC compliance and Navitus policies; update procedures as needed.
• Create credential activity reports for leadership and committees.
• Monitor credential databases and extract information from systems like HMS, NCPDP, OIG, DEA, and State Boards.

Skills

Verbal communication

Written communication

Data mining

Analytical skills

Multitasking

Education

High school diploma

Advanced degree preferred

Tools

Microsoft Office Suite

Credential databases

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on receiving, processing, and first-level evaluating provider credentials, working with NCPDP, HMS, DEA, and state/Federal databases to ensure qualified pharmacy networks and compliant providers.

The candidate will report to the Manager of Provider Services and support contract analysts, ensuring credentialing aligns with Navitus policies and URAC standards while maintaining professional