Reimbursement Specialist

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🔥 5 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $1.9k - $2.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

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.

📋 Description

• Responsible for ongoing monitoring of claims activity for accuracy and successful submission • Responsible for ensuring that patient billing information is set up appropriately in the pharmacy software • Participate, as necessary, in conferences and meetings related to reimbursement/billing • Responds to employee/patient/client questions or complaints regarding reimbursement and/or billing • Works with internal teams to review and resolve claim issues • Maintains accurate reference information relating to reimbursement and copay assistance • Responsible for accurate and thorough documentation of information, insurance and prescriptions/orders within the patient profile • Act in accordance with all applicable federal and state laws and with the highest ethical standards

🎯 Requirements

• High School Diploma or equivalent GED. • Some college preferred • CPhT preferred • Pharmacy technician license or pharmacy technician trainee license is strongly preferred in states requiring pharmacy technician licensure • Experience with pharmacy, health plan or clinical insurance claims billing, benefit assessments, billing/claims documentation, or claims auditing 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!