Administrator, Pharmacy Reimbursement

Navitus Health Solutions; Madison (WI); Remote; USD 47,000 - 57,000; Full time

Job summary

A leading healthcare company is seeking a Pharmacy Reimbursement Administrator to streamline claims adjudication processes. This remote role involves technical administration, data analysis, and quality assurance to ensure compliance and efficiency. Ideal candidates will have relevant experience and skills in pharmacy benefits management. Benefits include comprehensive health coverage, generous paid time off, and professional development support.

Benefits

Comprehensive health, dental, and vision insurance

20 days paid time off

401K match up to 5%

Referral bonus program

Qualifications

• Experience with pharmacy benefit manager or managed care is preferred.
• Previous testing experience is beneficial.
• Ability to work cooperatively with others.

Responsibilities

• Administers technical processes supporting electronic funds transfer.
• Ensures controls and reporting on claims processing.
• Tests pharmacy networks for accuracy.
• Identifies and escalates payment issues.

Skills

Technical process administration

Decision-making in pricing setup

Quality assurance

Data analysis

Interpersonal skills

Education

Associate Degree or equivalent experience

CPhT certification preferred

Job description

Job Title

Administrator, Pharmacy Reimbursement

Location

US

Job Type

Full-Time, Remote

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth.

Pay Range

USD $47,309.00 - USD $56,321.00 /Yr.

Work Schedule

M-F 8am-5pm, CT

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team! The Pharmacy Reimbursement Administrator (PRA) works in partnership with the Provider Relations Coordinators, IT Client Operations, and others to continually review, monitor, and update procedures to improve efficiencies of claims adjudication administration.

The PRA will test and review pharmacy networks to ensure that claims are adjudicating per Navitus' pharmacy contract agreements. The PRA is responsible for the process of pharmacy remittances, including the accuracy of data in pharmacy electronic payments (EFT) and/or 835-remittance advice and the oversight of recoveries of funds from pharmacies.

Responsibilities

How do I make an impact on my team?

• 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.
• Make decisions regarding the resolution of pharmacy network pricing setup issues.
• Develop processes to import and export data from Navitus systems.
• Responsible for pharmacy network rate testing, analysis and impact assessment
• Perform quality assurance to ensure accuracy in pharmacy network rates.
• 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

Qualifications

What our team expects from you?

• 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

What can you expect from Navitus?

• 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!