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Navitus Health Solutions · 2 hours ago

Analyst, Technical Operations Government Programs

Appleton, WI

Full-time

Onsite

Entry Level

$43K/yr - $51K/yr

1+ years exp

Navitus Health Solutions is a pharmacy benefit manager committed to making medications more affordable. The Analyst, Technical Operations Government Programs is responsible for executing government program processes in compliance with CMS regulations and ensuring accurate and timely completion of assigned tasks.

Health CareInformation Technology

Responsibilities

Assignments may include one or more of the following: Employer Group Waiver Plan (EGWP) enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing

Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk

Ensure process documentation accurately reflects the current process and update when necessary

Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications

Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance

Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution

As needed, may require working outside of normal business hours to complete time sensitive processes

Other duties as assigned

Qualification

Pharmaceutical claims adjudicationHealth plan organization experienceCompliance program supportBachelor/Associate DegreeCooperative interaction

Required

Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent

1+ years' work experience

Participate in, adhere to, and support compliance program objectives

The ability to consistently interact cooperatively and respectfully with other employees