Pharmacy Reimbursement Administrator

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $48.7k - $58k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🖥️ Administration

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

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

• Administer technical processes supporting system price setups, electronic funds transfer, and remittance setups according to policy • Ensure appropriate controls and oversight reporting across the end-to-end process • Identify, define, and implement new process controls as needed • Resolve pharmacy network pricing setup issues and research pricing inquiries • Develop processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx • Perform pharmacy network rate testing, analysis, and impact assessment • Perform ongoing quality assurance of pharmacy network rates to mitigate incorrect claims adjudication • Identify and escalate improper payments and 835 issues • Maintain department detail work instructions and policies • Monitor and report non-compliance relating to overpayments, transaction standard issues, and financial regulations • Provide offset detail to pharmacies impacted in a recovery project before receipt of payment and remit • Oversee applicable financial and metrics reporting, data dictionaries, inquiries, and audits • Submit service requests for necessary network updates, audit networks for price change accuracy, monitor compliance with pharmacy provider contracts, set up electronic payments and remits, and respond to payment issue questions • Make independent assessments to confirm compliance with contractual reimbursement obligations • Perform other duties as assigned

🎯 Requirements

• Associate Degree preferred or equivalent experience • CPhT preferred • PBM or managed care experience preferred, but not required • Previous testing experience preferred • Participate in, adhere to, and support compliance program objectives • 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%