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Coordinator Provider Credentials Remote
Coordinator Provider Credentials Remote-April 2024
Appleton
Apr 26, 2025
About Coordinator Provider Credentials Remote

  JOB REQUIREMENTS: Putting People First in Pharmacy- Navitus was foundedas an alternative to traditional pharmacy benefit manager (PBM) models.We are committed to removing cost from the drug supply chain to makemedications more affordable for the people who need them. At Navitus,our team members work in an environment that celebrates diversity,fosters creativity and encourages growth. We welcome new ideas and sharea passion for excellent service to our customers and each other. Due togrowth, we are adding Provider Credentials Coordinator to our ProviderServices department. We are unable to offer remote work to residents ofAlaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, NorthDakota, Rhode Island, South Carolina, South Dakota, West Virginia, andWyoming. The Coordinator I, Provider Credentials is responsible forfacilitating the receipt, processing, first level evaluation, andcreation of Internal and external reports of provider credentials. TheCoordinator I, Provider Credentials will work extensively with NCPDP,HMS, DEA, States\' provider databases, and Federal databases. Theindividual(s) in this position will report to the Manager of ProviderServices and support Pharmacy Relations Contract Analyst(s) to ensurethat all pharmacy providers are appropriately credentialed according tofederal and state regulations and statutes. The Coordinator I, ProviderCredentials is also accountable for ensuring the pharmacy credentialingprocess meets Navitus\' policies, complies with URAC standards, andensures that Navitus does not allow non-qualified pharmacies toparticipate and non-qualified prescribers to process claims. The role ofthe Coordinator I, Provider Credentials requires knowledge of pharmacyprocessing practices, pharmacy laws and regulations, and verbal andwritten communication skills. Is this you? Find out more below! How do Imake an impact on my team? Daily communication with Navitus pharmacyproviders, including Navitus\' strategic vendor(s), to obtain, review,and process credentials. Ensures that pharmacy credentials are received,documented in appropriate systems, and retained in pharmacy contractfiles. Audits files or systems to identify non-compliant documentation.Supports compliance to URAC and Navitus\' policy and procedures toensure a quality credentialed pharmacy network. Ability to enrich P&Psto meet new or updated statutes, laws, regulations, or guidance. Createreports of credential activity, including positive credentials, negativecredentials, issues associated with credentials, etc. Reports submittedto department VP and to Credential Committees. Monitors and extractsinformation from credential databases, such as HMS, NCPDP, OIG, DEA,State Boards of Pharmacy, and others as identified. Support PharmacyNetwork personnel in administration... For full info follow applicationlink. Navitus Health Solutions is an Equal Opportunity Employer:Disabled/Veterans/Male/Female/Minority/Other ***** APPLICATIONINSTRUCTIONS: Apply Online: ipc.us/t/ECBB62056C304C24

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