Coordinator, Provider Credentials

Responsibilities

• 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

Preferred

• advanced degree preferred

Benefits

• Remote work for 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, and Wisconsin.
• 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!
• Transparent, cost-effective pharmacy benefit management services.
• Madison, Wisconsin, USA
• https://www.navitus.com/
• Late Stage
• Leadership Team
• George Hepburn
• SVP and Chief Financial Officer
• Peter Beste
• CFO
• Recent News
• The Journal Record
• Oklahoma healthcare costs surge with premiums rising up to 75%
• 2026-09-28
• Business Wire
• Navitus releases Drug Trend Report, “Clarity for Action”
• 2026-05-14
• Morningstar.com
• Navitus Achieves HITRUST r2 Certification, Reinforcing Its Commitment to Cybersecurity and Information Protection
• 2026-01-19
• Company data provided by

Qualifications

• High school or equivalent
• Retail pharmacy experience or experience in a managed care pharmacy setting
• Prior experience analyzing medical and/or pharmacy claims or credentials
• 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
• Advanced degree preferred

Required skills

• Managed Care Pharmacy, Medical and Pharmacy Claims Analysis, Pharmacy Laws and Regulations, Pharmacy Processing Practices, Provider Communication, Provider Credentialing, Retail Pharmacy

Preferred skills

• advanced degree preferred

Experience

• Entry level