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Navitus Health Solutions · 9 hours ago

Administrator, Pharmacy Reimbursement

United States

Full-time

Remote

New Grad, Entry Level

$47K/yr - $56K/yr

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.

Health CareInformation Technology

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

Qualification

Pharmacy Benefit ManagementClaims AdjudicationData AnalysisQuality AssuranceCompliance SupportTesting ExperienceTeam CollaborationCommunication Skills