Remote Provider Credentials Coordinator I

Navitus; Helena (MT); Remote; USD 42,000 - 70,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Ml

Job summary

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to process and document provider credentials, and generate internal/external reports. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing.

Reporting to the Manager of Provider Services, you will support Pharmacy Relations Contract Analysts and uphold Navitus policies and URAC standards. Strong communication is essential.

Qualifications

• High school or equivalent; advanced degree preferred.
• Experience in retail pharmacy or managed care setting desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desired.
• Ability to work independently with strong telephonic and written communication.
• Proficient with Microsoft applications and ability to interact with providers at all levels.

Responsibilities

• Process credentials and create internal/external credentialing reports.
• Maintain credentials in systems and audit for completeness.
• Ensure URAC and Navitus policy compliance in credentialing.
• Create credential activity reports for VP and Committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, State Boards).
• Support resolution of provider pricing questions and processing requirements.
• Assist in obtaining annual Fraud, Waste, and Abuse attestations.
• Update systems to reflect external database data.
• Assist in network strategy development.
• Perform other duties as assigned.

Skills

Verbal and written communication

Data mining

Analytical skills

Independent worker

Interdepartmental collaboration

Education

High school or equivalent

Advanced degree preferred

Tools

Microsoft Office

Job description

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to process and document provider credentials, and generate internal/external reports. You will work with NCPDP, HMS, DEA, and state/federal databases to ensure compliant credentialing.

Reporting to the Manager of Provider Services, you will support Pharmacy Relations Contract Analysts and uphold Navitus policies and URAC standards. Strong communication is essential.