Remote Provider Credentials Coordinator I

Navitus; Columbus (OH); Remote; USD 38,000 - 52,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K match

Adoption assistance

Flexible spending account

Education assistance

Professional membership assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to manage credentialing workflows for internal and external providers. You will process credentials, audit files, and generate reports to support a compliant provider network.

The role requires knowledge of pharmacy processing practices, strong communication skills, and ability to work independently while coordinating with various departments to ensure timely credentialing and adherence to regulations.

Qualifications

• Knowledge of pharmacy processing practices and regulations.
• Experience analyzing medical/pharmacy claims or credentials is desirable.
• Ability to work independently and manage multiple priorities.
• Strong verbal and written communication with providers at all levels.

Responsibilities

• Communicate daily with Navitus pharmacy providers and vendors to obtain and review credentials.
• Ensure credentials are documented and audits identify non-compliant documentation.
• Support URAC compliance and Navitus policy adherence.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist in provider program administration and issue resolution.
• Support annual attestations (Fraud, Waste & Abuse) as required.
• Update systems to reflect external database data.
• Assist in network strategy development and implementation.
• Perform other duties as assigned.

Skills

Pharmacy industry knowledge

Independent work

Telephone communication

Written communication

Analytical skills

Data mining databases

multitasking

Policy and compliance awareness

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 manage credentialing workflows for internal and external providers. You will process credentials, audit files, and generate reports to support a compliant provider network.

The role requires knowledge of pharmacy processing practices, strong communication skills, and ability to work independently while coordinating with various departments to ensure timely credentialing and adherence to regulations.