Remote Provider Credentials Coordinator

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

Ventajas ofrecidas por este puesto de trabajo

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!

Descripción de la vacante

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on processing provider credentials, ensuring compliance with URAC standards, and maintaining accurate records across multiple databases.

You will work with NCPDP, HMS, DEA, and state/federal databases to support credentialing and reporting, reporting to the Manager of Provider Services, and collaborating with Pharmacy Relations and Contract Analysts.

Formación

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy experience or managed care setting desired.
• Experience analyzing medical or pharmacy claims or credentials is highly desired.
• Ability to work independently with telephonic and written communication skills.
• Must interact professionally with providers at all levels.

Responsabilidades

• Daily communication with Navitus pharmacy providers, including Navitus’ strategic vendor(s), to obtain, review, and process credentials.
• Ensures that pharmacy credentials are received, documented in appropriate systems, and retained in pharmacy contract files.
• Audits files or systems to identify non-compliant documentation.
• Create reports of credential activity and submit to dept VP and Credential Committees.
• Monitors and extracts information from credential databases (HMS, NCPDP, OIG, DEA, State Boards, etc.).
• Support Pharmacy Network in administration of Navitus programs and pricing questions.
• Assist in obtaining attestations from providers and other required attestations.
• Update systems to reflect data from external databases as appropriate.
• Support network strategies under VP and Network Development.
• Other duties as assigned.

Conocimientos

Independent work

Telephonic communication

Written communication

Analytical skills

Multitasking

Provider interaction

Educación

High school or equivalent

Advanced degree preferred

Herramientas

Microsoft Office

Descripción del empleo

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. The role focuses on processing provider credentials, ensuring compliance with URAC standards, and maintaining accurate records across multiple databases.

You will work with NCPDP, HMS, DEA, and state/federal databases to support credentialing and reporting, reporting to the Manager of Provider Services, and collaborating with Pharmacy Relations and Contract Analysts.