Navitus Health Solutions · 1 day ago
Analyst, UM
United States
Full-time
Remote
Entry Level
$50K/yr - $59K/yr
2+ years exp
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Responsibilities
Requires deep subject matter expert knowledge of the PA Criteria and revision process and/or PA Notification process
Understand business processes and how they relate to technical setup in the PA system, making suggestions and changes that will improve business processes
Configure and test administration changes required in the systems within required turn-around times. Ensure the enhancement meets the business need and can be administered in an efficient fashion
Implement new client prior authorization benefit designs
Ensure clinical workflows are built and notification letters meet regulatory requirements
Participate in and support capacity planning and the development of long-term strategic goals for systems and software in conjunction with end-users, third party vendors, and department managers
Maintain prior authorization benefit designs with a high degree of accuracy as validated through audits and testing
Audit prior authorization setup to ensure it aligns with the client’s expectations, and/or government regulations
Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs
Adhere to governmental regulations (i.e., HIPAA, CMS, etc.) and processes while executing tasks, when applicable
Other duties as assigned
Qualification
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Required
One of the following required: College degree in a science or business-related field, CPhT, or at least 2 years’ experience in a related field (PBM, Health Insurance, and/or Prior Authorization)
Experience and expertise in working across multiple departments, technical and business acumen, and a 'track record' of tangible success
Intermediate to expert knowledge of the Microsoft Office Suite
Experience documenting and maintaining configuration and process information
Requires detailed documentation of application changes
Hands-on troubleshooting experience with a complex multi-user business application
Knowledge of workflow management systems including role and document management
Knowledge of Medicare D regulatory requirements required prior to or soon after hire
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
Preferred
Prior experience with Prior Authorization, or within a PBM preferred
Knowledge of prior authorization processes in a health care environment preferred
Experience implementing processes to meet regulatory compliance requirements
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
Navitus Health Solutions
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company.
1,001-5,000 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
Company data provided by crunchbase
