Remote Provider Credentialing Specialist

Navitus Health Solutions, LLC; Butlerville (IN); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Prof. 

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role oversees the receipt, processing, first level evaluation, and reporting of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will ensure credentialing compliance with Navitus policies and URAC standards, enabling qualified pharmacies to participate and qualified prescribers to process claims.

Qualifications

• High school or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Experience analyzing medical and/or pharmacy claims or credentials.
• Ability to work independently with telephonic and written communication, data mining, and analytical skills.
• Ability to interact professionally with providers at all levels.
• Proficient in Microsoft applications.
• Adherence to compliance program objectives.
• Collaborates effectively with other departments.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensures credentials are documented in systems and retained in contract files; audits for non-compliance.
• Supports URAC compliance and company policies; updates procedures for new regulations.
• Create reports of credential activity for department VP and Credential Committees.
• Monitors credential databases (NCPDP, HMS, OIG, DEA, State Boards) and updates as needed.
• Assist Pharmacy Network team with provider programs and pricing questions.
• Support annual Fraud, Waste, and Abuse attestations from providers.
• Update external databases to reflect accurate data.
• Assist VP and Network Development in strategy decisions.

Skills

Microsoft Office

Data mining

Verbal & written communication

Independent work

Provider credentialing

Education

High school or equivalent

Tools

NCPDP

HMS

DEA

State Boards of Pharmacy

NAVPADS/DB systems

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. This role oversees the receipt, processing, first level evaluation, and reporting of provider credentials, working with NCPDP, HMS, DEA, and state/federal databases.

You will ensure credentialing compliance with Navitus policies and URAC standards, enabling qualified pharmacies to participate and qualified prescribers to process claims.