Remote Provider Credentials Coordinator

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

Benefits offered by this job

Health, Dental, 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 Pro/Mb

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, first level evaluation, and reporting of provider credentials across internal and external systems, working with NCPDP, HMS, DEA, States’ databases, and Federal databases.

You will report to the Manager of Provider Services, support Pharmacy Relations Contract Analysts, ensure credentialing meets Navitus policies and URAC standards, and help prevent non-qualified

Qualifications

• Independent work with minimal supervision.
• Strong telephonic and written communication skills.
• Ability to data-mine variable databases and analyze information.
• Experience analyzing medical/pharmacy claims or credentials is desired.
• Comfort with multiple priorities and attention to detail.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented and retained in appropriate systems; audit non-compliant docs.
• Support URAC compliance and Navitus policy; update procedures as statutes change.
• Create credential activity reports for department VP and committees.
• Monitor credential databases such as HMS, NCPDP, OIG, DEA, and State Boards.
• Assist Network Development in evaluating pharmacy network strategies.
• Support annual Fraud, Waste, and Abuse attestations from providers.
• Update systems with data aligned to external databases.
• Collaborate with Pharmacy Relations and Contract Analysts as needed.
• Other duties as assigned.

Skills

Work independently

Telephonic communication

Written communication

Data mining

Analytical skills

Multitasking

Microsoft Office

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, first level evaluation, and reporting of provider credentials across internal and external systems, working with NCPDP, HMS, DEA, States’ databases, and Federal databases.

You will report to the Manager of Provider Services, support Pharmacy Relations Contract Analysts, ensure credentialing meets Navitus policies and URAC standards, and help prevent non-qualified