CompanyNavitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications 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 share a passion for excellent service to our customers and each other.. Current associates must use SSO login option at

to be considered for internal opportunities. _ We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $20.19 - USD $23.75 /Hr.

STAR Bonus % (At Risk Maximum) 0.00 - Ineligible

Work Schedule Description (e.g. M-F 8am to 5pm) 8:30am to 5pm

Remote Work Notification

ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

Overview

Navitus Health Solutions is seeking a Coordinator I, Provider Credentials to join our team!
The Coordinator I, Provider Credentials is responsible for facilitating the receipt, processing, first level evaluation, and creation of Internal and external reports of provider credentials. The Coordinator I, Provider Credentials will work extensively with NCPDP, HMS, DEA, States’ provider databases, and Federal databases. The individual(s) in this position will report to the Manager of Provider Services and support Pharmacy Relations Contract Analyst(s) to ensure that all pharmacy providers are appropriately credentialed according to federal and state regulations and statutes. The Coordinator I, Provider Credentials is also accountable for ensuring the pharmacy credentialing process meets Navitus’ policies, complies with URAC standards, and ensures that Navitus does not allow non-qualified pharmacies to participate and non-qualified prescribers to process claims. The role of the Coordinator I, Provider Credentials requires knowledge of pharmacy processing practices, pharmacy laws and regulations, and verbal and written communication skills.
Is this you? Find out more below!
Responsibilities

How do I make an impact on my team?
Daily communication with Navitus pharmacy providers, 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 contract files. Audits files or systems to identify non-compliant documentation
Supports compliance to URAC and Navitus’ policy and procedures to ensure a quality credentialed pharmacy network. Ability to enrich P&Ps to meet new or updated statutes, laws, regulations, or guidance
Create reports of credential activity, including positive credentials, negative credentials, issues associated with credentials, etc. Reports submitted to department VP and to Credential Committees
Monitors and extracts information from credential databases, such as HMS, NCPDP, OIG, DEA, State Boards of Pharmacy, and others as identified
Support Pharmacy Network personnel in administration of the Navitus pharmacy programs with providers, resolution of pharmacy contractual pricing questions or issues, communication of processing requirements to providers and general resolution of processing issues
Supports obtaining and reporting of annual Fraud, Waste, and Abuse attestations from providers. Supports obtaining other attestations as required supporting Navitus business practices
Updates systems to reflect data consistent with external databases, such as NCPDP, as appropriate
Assists VP and other Network Development associates in the determination, review, and implementation of pharmacy network strategies
Other duties as assigned
Qualifications

What our team expects from you?
High school or equivalent, advanced degree preferred
Retail pharmacy experience or experience in a managed care pharmacy setting desired
Prior experience analyzing medical and/or pharmacy claims or credentials highly desired
Ideal candidate will be able to work independently, have telephonic and written communication skills, data-mine variable databases, analytical skills and can manage multiple priorities
Ability to professionally interact with providers at all levels (both internal and external) is required
Must be able to function independently, however work closely with individuals within other departments
Candidate must be proficient in Microsoft applications
Candidate must rely on knowledge of Navitus’ business concepts, practices, and policies and procedures to accomplish goals
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750!

LI-Remote

Location : Address

Remote

Location : Country

US