Remote Provider Credentials Coordinator I

Navitus Health Solutions, LLC; Kansas City (MO); Remoto; USD 28.000 - 33.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, Dental, Vision insurance

20 days paid time off

Parental leave (4 weeks)

9 paid holidays

401K match up to 5%

Adoption Assistance Program

Flexible Spending Account

Education & Membership assistance

Referral Bonus up to $750

Descrizione del lavoro

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, evaluation and reporting of provider credentials, working with NCPDP, HMS, DEA and state/federal databases.

You will ensure compliance with Navitus policies and URAC standards while supporting credentialing across the pharmacy network. The role requires knowledge of pharmacy processing practices and strong verbal and written communication.

Competenze

• High school or equivalent is required; an advanced degree is preferred.
• Retail pharmacy experience or managed care pharmacy setting is desirable.
• Prior experience analyzing medical and/or pharmacy claims or credentials is highly desirable.
• Ability to work independently, with strong telephonic and written communication skills, and to data-mine variable databases.

Mansioni

• Daily communication with Navitus pharmacy providers and strategic vendors to obtain, review and process credentials.
• Ensure credentials are received and documented in appropriate systems; audit for non-compliant documentation.
• Support URAC compliance and Navitus policies; update procedures to meet new regulations.
• Create reports of credential activity and submit to department leadership.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards) and extract required information.
• Assist Pharmacy Network team with provider communications and pricing questions.
• Support attestations related to Fraud, Waste, and Abuse and other required attestations.
• Update systems to reflect data consistent with external databases.
• Assist in determining and implementing pharmacy network strategies.
• Perform other duties as assigned.

Conoscenze

Communication skills

Data mining

Analytical skills

Multitasking

Provider interaction

Independent worker

Formazione

High school or equivalent

Advanced degree preferred

Strumenti

Microsoft Office

Descrizione del lavoro

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team. You will facilitate receipt, processing, evaluation and reporting of provider credentials, working with NCPDP, HMS, DEA and state/federal databases.

You will ensure compliance with Navitus policies and URAC standards while supporting credentialing across the pharmacy network. The role requires knowledge of pharmacy processing practices and strong verbal and written communication.