Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is committed to making medications more affordable by serving as an alternative pharmacy benefit manager. The Pharmacy Reimbursement Administrator will work with various teams to improve claims adjudication processes and ensure compliance with pharmacy contract agreements.
Responsibilities
- Administers technical processes in support of system price setups, electronic funds transfer and remittance setups according to policy
- Ensures appropriate controls and oversight reporting on the end-to-end process. If process controls are absent, the expectation is to identify, define, and implement new ones as needed
- Make decisions regarding the resolution of pharmacy network pricing setup issues. Research pricing inquiries from pharmacies and internal teams
- Develop processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx
- Responsible for pharmacy network rate testing, analysis and impact assessment
- Perform quality assurance to ensure accuracy in pharmacy network rates on an ongoing basis to mitigate the risk of incorrect claims adjudication
- Appropriately identify and escalate improper payments and 835 issues
- Maintenance of department detail work instructions and policies
- Monitoring and reporting of non-compliance relating to overpayments, transaction standard issues and financial regulations
- Provide offset detail to pharmacies impacted in a recovery project prior to receipt of payment and remit
- Responsible for oversight of applicable financial and metric’s reporting, data dictionaries, inquiries, and audits
- Other duties as assigned
Skills
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
- Associate Degree preferred or equivalent experience
- CPhT preferred
- PBM or managed care is preferred, but not required
- Previous testing experience is preferred
Benefits
- 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!
Company Overview
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company. It was founded in 2003, and is headquartered in Appleton, Wisconsin, USA, with a workforce of 1001-5000 employees. Its website is https://www.navitus.com/.
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