Analyst, Pharmacy Contract Audit

Navitus; Denver (CO); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Parental leave

401(k) with match

Educational assistance

Job summary

Navitus is seeking an Analyst, Pharmacy Contract Audit to oversee contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will review claims data, audit networks for price changes, and ensure compliance with contracts using NCRx and PC2 systems.

Collaborate with multiple teams to remediate errors and validate terms. You will interpret contract language, investigate pricing discrepancies, and develop controls to improve end-to-end contract pricing processes.

Qualifications

• Bachelor's degree or equivalent; emphasis in business, finance, economics, or operations preferred.
• Minimum two years analytics experience required.
• Support compliance program objectives and collaborate with teams.

Responsibilities

• Analyze and resolve pricing and contractual inquiries from providers, clients, and internal teams.
• Interpret contract language and compare pricing to adjudicated activity.
• Develop controls and oversight reporting for contract pricing across Retail, Specialty, and Mail Order.
• Perform rate testing, chain audits, and impact assessments.
• Prepare periodic reports on contractual compliance for Provider Services and leadership.

Skills

Analytics

Business acumen

Interpersonal skills

Education

Bachelor's degree or equivalent

Job description

Overview

Due to growth, we are adding a Analyst, Pharmacy Contract Audit to our team!

The Analyst, Pharmacy Contract Audit is responsible for the oversight of Navitus' contractual pharmacy network reimbursement accuracy. The individual in this position is expected to make independent assessments to confirm Navitus is conforming to contractual reimbursement obligations contained in Retail, Specialty, and Mail Order pharmacy agreements. The Analyst will continually review and monitor claims data, create, and update procedures, audit networks for price change accuracy, monitor compliance with Navitus pharmacy provider contracts, communicate findings, and work with applicable teams to remediate errors. The Analyst works closely with inter and intra-departmental resources to interpret and understand contractual terms, client network selections, and how they are operationalized in applicable systems. The Analyst will be knowledgeable of business operations, utilizing Navitus' adjudication system (NCRx) and contracting and credentialing databases (PC2), among other applications. Provider, client, and network performance will be analyzed in support of network development, quality control, and compliance with contractual terms, including effective rate and other aggregate tracking mechanisms. As part of the Provider Relations team, the Analyst will be responsible for creating an array of reports to validate systems accuracy to Retail, Specialty, and Mail Order contractual terms.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Analytical and operational understanding of Navitus' reimbursement programs including AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, and other pricing structures
• Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, auditors, and internal teams regarding Retail, Specialty, and Mail Order pricing errors with focus on the root cause
• Interpret pharmacy contract language to compare Retail, Specialty, and Mail Order contract pricing to adjudicated claims activity
• Develop and maintain appropriate controls and oversight reporting on the end-to-end process of Retail, Specialty, and Mail Order contract pricing. If process controls are absent, the expectation is to identify, define, and implement new processes as needed
• Responsible for pharmacy network rate testing, chain audits, analysis, and impact assessment
• Make decisions regarding the resolution of pharmacy network pricing setup issues
• Submit service requests, recovery requests, and/or engage applicable teams to make system updates/changes
• Understand, follow, and improve current operational and administrative processes
• Periodic and detailed reporting of contractual compliance activities and opportunities to Provider Services team and cross-functional leadership
• Other duties as assigned

Qualifications

What our team expects from you?

• Bachelor's degree or equivalent experience required. Emphasis in business, finance, economics, or operations preferred
• Minimum two years analytics experience required
• 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!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.

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