Coordinator, Provider Credentials

Navitus • Montpelier, VT • 8h ago

This job was posted by https://www.vermontjoblink.com : For more information, please see: https://www.vermontjoblink.com/jobs/1433888\ \ 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

\ \ \ \ Equal employment opportunity, including veterans and individuals with disabilities.\ \

PI288057794

Navitus

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