Coordinator, Provider Credentials

Navitus Health Solutions, LLC•,

8d•$20 - $24•Remote

About The Position

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials. This role facilitates the receipt, processing, first-level evaluation, and reporting of provider credentials. The coordinator works extensively with NCPDP, HMS, DEA, state provider databases, and federal databases. Reporting to the Manager of Provider Services, the coordinator supports Pharmacy Relations Contract Analysts to ensure pharmacy providers are credentialed according to federal and state regulations and statutes. The role helps ensure that the pharmacy credentialing process meets Navitus policies and URAC standards, and that non-qualified pharmacies and prescribers are not permitted to participate or process claims. It calls for knowledge of pharmacy processing practices, pharmacy laws and regulations, and strong verbal and written communication skills. The position is listed as remote, with remote work available only to residents of the states and Washington, DC specified in the posting. The stated schedule is 8:30 a.m. to 5:00 p.m.

Requirements

High school diploma or equivalent.
Ability to work independently while collaborating closely with individuals in other departments.
Telephonic and written communication skills.
Ability to analyze data from variable databases and apply analytical skills while managing multiple priorities.
Ability to interact professionally with providers at all levels, both internal and external.
Proficiency in Microsoft applications.
Ability to use knowledge of Navitus business concepts, practices, policies, and procedures to accomplish goals.
Participate in, adhere to, and support compliance program objectives.
Consistently interact cooperatively and respectfully with other employees.

Nice To Haves

An advanced degree is preferred.
Retail pharmacy experience or experience in a managed care pharmacy setting is desired.
Prior experience analyzing medical and/or pharmacy claims or credentials is highly desired.

Responsibilities

Communicate daily with Navitus pharmacy providers, including strategic vendors, to obtain, review, and process credentials.
Ensure pharmacy credentials are received, documented in appropriate systems, and retained in pharmacy contract files; audit files and systems for non-compliant documentation.
Support compliance with URAC standards and Navitus policies and procedures, including helping update policies and procedures to address new or revised statutes, laws, regulations, or guidance.
Create reports on credential activity, including positive and negative credentials and credential-related issues, for the department VP and Credential Committees.
Monitor and extract information from credential databases, including HMS, NCPDP, OIG, DEA, and State Boards of Pharmacy.
Support Pharmacy Network personnel in administering pharmacy programs, resolving contractual pricing questions or issues, communicating processing requirements to providers, and resolving processing issues.
Support obtaining and reporting annual Fraud, Waste, and Abuse attestations from providers, as well as other attestations required for Navitus business practices.
Update systems to reflect data consistent with external databases such as NCPDP, as appropriate.
Assist the VP and Network Development associates in determining, reviewing, and implementing pharmacy network strategies.
Perform other duties as assigned.