Remote Provider Credentials Coordinator - URAC/Compliance

Navitus Health Solutions, LLC; Central City (CO); Remote; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus

Job summary

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team in Colorado. The role involves facilitating receipt, processing, and reporting of provider credentials, interfacing with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support related analysts to ensure credentialing meets Navitus’ policies and URAC standards.

Qualifications

• Must be able to work independently and manage multiple priorities.
• Strong telephonic and written communication skills.
• Experience analyzing medical/pharmacy claims or credentials is desirable.

Responsibilities

• Daily communication with Navitus pharmacy providers and vendors to obtain, review, and process credentials.
• Ensure credentials are documented and audited for compliance.
• Support URAC compliance and update procedures for new laws/regulations.
• Create credential activity reports for leadership and committees.
• Monitor credential databases (HMS, NCPDP, OIG, DEA, State Boards).
• Assist in resolving pricing questions and processing requirements with network teams.
• Support attestations and other regulatory reporting as required.
• Update systems to reflect external databases and regulatory data.
• Assist in developing and implementing pharmacy network strategies.
• Perform other duties as assigned.

Skills

Independent work

Telephonic communication

Analytical skills

Multitasking

Microsoft Office

Education

High school or equivalent

Job description

Navitus Health Solutions, LLC is seeking a Coordinator I, Provider Credentials to join our team in Colorado. The role involves facilitating receipt, processing, and reporting of provider credentials, interfacing with NCPDP, HMS, DEA, and state/federal databases.

You will report to the Manager of Provider Services and support related analysts to ensure credentialing meets Navitus’ policies and URAC standards.