Remote Provider Credentialing Specialist

Navitus Health Solutions, LLC; Iowa; Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health, Dental & Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational & Membership assistance

Referral Bonus up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating the receipt, processing, and first-level evaluation of provider credentials across various databases and systems.

The incumbent will work with NCPDP, HMS, DEA, and state boards, ensuring credentialing aligns with federal and state regulations, Navitus policies, and URAC standards while supporting other contract analysts and network development activities.

Qualifications

• High school or equivalent, advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Experience analyzing medical or pharmacy claims or credentials.
• Ability to work independently with telephonic and written communication, data-mining databases, and prioritization.

Responsibilities

• Daily communication with Navitus pharmacy providers to obtain, review, and process credentials.
• Ensure credentials are documented and archived; audit for non-compliance.
• Support URAC compliance and update procedures to meet statutes and guidance.
• Create credential activity reports for VP and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist in administering Navitus pharmacy programs and pricing questions.
• Obtain and report attestations from providers as required.
• Update systems to reflect data from external databases.
• Assist leadership in pharmacy network strategies.
• Other duties as assigned.

Skills

Communication skills

Multi-tasking

Analytical skills

Microsoft Office

Education

High school diploma or equivalent

Advanced degree preferred

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on facilitating the receipt, processing, and first-level evaluation of provider credentials across various databases and systems.

The incumbent will work with NCPDP, HMS, DEA, and state boards, ensuring credentialing aligns with federal and state regulations, Navitus policies, and URAC standards while supporting other contract analysts and network development activities.