Navitus Health Solutions · 1 week ago
Analyst, PA Accel
United States
Full-time
Remote
Mid Level
$55K/yr - $66K/yr
4+ years exp
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Responsibilities
Prepare analyses and work orders for pharmacy drug prior authorization criteria sets, which can be configured in our automated prior authorization system.
Completes scheduled and urgent Prior Authorization criteria additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards.
Analyze and report on program specific data associated with PA Accel.
Ensure automated prior authorization continues to function as intended and is scalable to Navitus’ clients.
Coordinate enhancement efforts with Product Manager, and aid in user tests as they are implemented.
Onboard new and existing clients onto the automated PA platform.
Complies with standards set forth regarding automated Prior Authorization benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards.
Be an internal point of contact on this product and work with cross-functional teams to audit, implement, enhance, train, and explain the benefits of the product.
Other duties as assigned
Qualification
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Required
A minimum of a Bachelor's Degree in a science, business, or mathematics related field, or at least four years of equivalent work experience is required.
Experience with Prior Authorization and/or reporting and a 'track record' of tangible success, and team collaboration/relationship-building/management is essential.
Must be able to exercise appropriate judgment.
Intermediate experience with Excel required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.
Preferred
Experience with pharmacy prior authorization or PBM knowledge 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
Company
Navitus Health Solutions
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company.
1001-5000 employees
H1B Sponsorship
Navitus Health Solutions has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2022 (1)
Funding
Current Stage
Late StageLeadership Team
Shayna Schulz
Chief Operations Officer
Recent News
2024-12-11
Modern Healthcare
2024-12-05
Company data provided by crunchbase
