Navitus Health Solutions · 1 day ago
Reimbursement Analyst, Pharmacy Network
United States
Full-time
Remote
Entry Level
$53K/yr - $73K/yr
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Responsibilities
Operation and timely administration of the Navitus generic pricing programs including MAC, NADAC, or other pricing structures, which includes determining products to be included on the MAC list and the associated price per unit and updating all pricing within Navitus systems.
Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, and internal teams.
Understand, follow, and assist with improvements to current operational and administrative processes.
Evaluate state MAC requirements to ensure Navitus MAC management remains compliant.
Monitor industry events to determine availability of generic introduction to the marketplace and manage exclusivity timeline for newly introduced generics.
Manage consolidation of generic manufacturers in the market that will affect MAC pricing.
Continuously review and pro-actively identify areas of opportunities for pricing and discount performance improvement, including analysis and communication of reimbursement activities.
Make decisions regarding the resolution of pharmacy issues.
Research customer and contract issues that may affect account planning, strategies, and proposals. Assists with RFP responses as necessary.
Develop and execute effective communication vehicles to disseminate accurate and concise information to network providers.
Periodic and detailed reporting of activities and opportunities to Provider Services team and cross-functional leadership.
Research external and internal pricing trends and opportunities to contribute to overall pricing strategy.
Perform analyses as requested by internal and external business owners, or in support of identified business objectives, with special focus on pharmacy network profitability and/or client discounts.
Develop understanding of contractual terms and performance to assist in developing and enhancing network strategies, pricing decisions, and contract language.
Identify, advocate, and implement continual process improvement of policies and procedures to maximize quality and efficiencies.
Perform quality assurance to ensure accuracy in pricing and processes and share results with leadership.
Assist with internal department and corporate projects as required.
Solve moderately complex problems.
Other related duties as assigned/required.
Qualification
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Required
Ideal candidate will be detailed and well-organized, with both interpersonal and analytical skills, and can manage multiple priorities.
Ability to professionally interact with providers and/or clients at all levels of the organization (both internal and external) is required.
Ability to retrieve and analyze large sets of data to aid in pricing decision making.
Must be able to function independently while also working closely with individuals within other departments.
Candidate must rely on knowledge of Navitus’ business concepts, practices, and procedures to accomplish goals.
Ability to prioritize work to meet a need.
Strong team orientation and the ability to work with a variety of people.
Excellent verbal and written communication as well as strong organizational skills.
Able to take direction to meet departmental objectives.
PC skills: Microsoft Excel, Access, and other applications as required.
Extensive analytical skills.
Ability to research, analyze and problem solve.
Detail oriented.
Judgment and Decision-making.
Ability to build and manage relationships.
Basic understandings of overall business risk to company.
Self-starter who can work independently.
Prepare and execute project management documents.
High level communication skills (written, verbal/presentation and active listening).
Ability to work independently and prioritize work to meet Navitus’ and clients’ needs.
Collaborative team building.
Understand the sense of urgency to complete the job.
Absolute and uncompromising integrity with the ability to instill trust, integrity, fairness, credibility, and a sense of urgency.
Ability to multi-task in a fast environment with minimum supervision.
The ability to consistently interact cooperatively and respectfully with other employees.
Preferred
Emphasis in business, finance, economics, or actuarial science strongly preferred.
Recent college graduates are encouraged to apply.
Company
Navitus Health Solutions
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company.
Founded in 2003
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
Shayna Schulz
Chief Operations Officer
Recent News
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