Remote Provider Credentialing Specialist

Navitus; Raleigh (NC); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

9 holidays

401K match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to support the credentialing process for pharmacy providers. The role involves processing credentials, maintaining documentation, and ensuring compliance with URAC and Navitus policies.

The position requires strong communication skills, the ability to work independently, and experience with credentialing databases and claims data. Remote-friendly role with exposure to NCPDP, HMS, DEA, and state boards.

Qualifications

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

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are received, documented, and retained in files; audit for non-compliance.
• Support URAC compliance and Navitus policies; update procedures for new statutes or guidance.
• Create reports of credential activity; present to VP and Credential Committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Support pharmacy network staff with credentialing questions and processing requirements.
• Assist in obtaining annual attestations from providers and other required attestations.
• Update systems to reflect external database data; coordinate with Navitus teams.
• Assist in determining and implementing pharmacy network strategies.
• Perform other duties as assigned.

Skills

Communication skills

Data analysis

Independent work

Microsoft Office

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office Suite

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to support the credentialing process for pharmacy providers. The role involves processing credentials, maintaining documentation, and ensuring compliance with URAC and Navitus policies.

The position requires strong communication skills, the ability to work independently, and experience with credentialing databases and claims data. Remote-friendly role with exposure to NCPDP, HMS, DEA, and state boards.