Pharmacy Reimbursement Administrator

September 18

🐻 Alaska – Remote

Although this job is listed in Alaska, this company may be open to hiring remote in other states.

🌺 Hawaii – Remote

Although this job is listed in Hawaii, this company may be open to hiring remote in other states.

+11 more states

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $47.3k - $56.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🖥️ Administration

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Navitus Health Solutions

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Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

📋 Description

• 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

🎯 Requirements

• Associate Degree preferred or equivalent experience. • CPhT preferred • PBM or managed care is preferred, but not required • Previous testing experience is preferred • Participate in, adhere to, and support compliance program objectives • The ability to consistently interact cooperatively and respectfully with other employees

🏖️ 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!