Remote Provider Credentials Coordinator I

Navitus; Madison (WI); Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K match 5%

Adoption assistance

FSA

Education assistance

Membership assistance

Referral bonus

Job summary

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to support credentialing for pharmacy providers. You will work with NCPDP, HMS, DEA, and state and federal databases to process credentials and generate reports.

You will ensure compliance with URAC standards and Navitus policies, maintain accurate contractor files, and assist with annual attestations and credentialing workflows in a fast-paced, team-driven environment.

Qualifications

• High school diploma or equivalent; advanced degree preferred.
• Retail pharmacy or managed care experience desired.
• Experience analyzing medical/pharmacy claims or credentials.
• Strong independent work, telephonic and written communication, data mining, and multitasking.
• Proficient in Microsoft applications and Navitus policies.

Responsibilities

• Process, review, and document credentials for pharmacy providers.
• Maintain credentials in systems and audit for compliance.
• Support URAC and Navitus policy adherence and update procedures.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (NCPDP, HMS, OIG, DEA, Boards).
• Assist in resolving provider questions and pricing/processing issues.

Skills

Credentialing

Data analysis

Communication skills

Microsoft Office Suite

Education

High school diploma or equivalent

Advanced degree preferred

Tools

Microsoft Office Suite

Job description

Navitus Health Solutions seeks a Coordinator I, Provider Credentials to support credentialing for pharmacy providers. You will work with NCPDP, HMS, DEA, and state and federal databases to process credentials and generate reports.

You will ensure compliance with URAC standards and Navitus policies, maintain accurate contractor files, and assist with annual attestations and credentialing workflows in a fast-paced, team-driven environment.