Coordinator II, Provider Credentials

Company

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

Remote Work Notification

Hiring Manager : Full Name: First Last

Overview

Due to growth, we are adding a Coordinator II, Provider Credentials to our team.

The Coordinator II, Provider Credentials is responsible for facilitating the receipt, processing, first level evaluation, and creation of internal and external reports of provider credentials. The Provider Credentials Coordinator will work extensively with several credentialing databases and will report to the Assoc. Manager, Provider Services and operations, 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 II, Provider Credentials is also accountable for ensuring the pharmacy credentialing process meets Navitus’ policies and 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 II, 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
• Pharmacy certification a plus
• Ability to professionally interact with providers at all levels (both internal and external) is required
• Candidate must be proficient in Microsoft applications
• Retail pharmacy experience or experience in a managed care pharmacy setting desired
• Prior experience analyzing medical and/or pharmacy claims or credentials are 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
• Must be able to work closely with individuals within other departments
• 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!

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