Analyst, Pharmacy Contract Audit

Navitus Health Solutions, LLC

United States

Remote

USD 54,000 - 65,000

Full time

5 days ago

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Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Parental Leave (4 weeks)

Holidays (9)

401K Match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program

Job summary

Navitus is seeking an Analyst, Pharmacy Contract Audit to oversee contractual reimbursement accuracy across Retail, Specialty, and Mail Order, using NCRx and PC2 to analyze claims and contract terms.

The role will create reports, test pricing, and resolve inquiries from providers, clients, and auditors, partnering with Provider Services to ensure compliant rate calculations.

Qualifications

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

Responsibilities

Analytical and operational understanding of Navitus’ reimbursement programs including pricing structures (AWP, WAC, MAC, NADAC, FUL, AAC)
Field inquiries from providers, clients, auditors, and internal teams regarding pricing errors with focus on the root cause
Interpret contract language to compare contract pricing to adjudicated claims activity
Develop and maintain controls and oversight reporting on end-to-end pricing processes
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 and engage teams to make system updates/changes
Understand, follow, and improve current operational processes
Periodic reporting of contractual compliance activities to Provider Services and leadership
Other duties as assigned

Skills

Analytical skills

Data analysis

Communication

Problem solving

Stakeholder engagement

Education

Bachelor's degree

Tools

NCRx adjudication system

PC2 database

Job description

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. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $54,236.00 - USD $64,567.00 /Yr.

STAR Bonus % (At Risk Maximum)

10.00 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8:00am-5:00pm

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

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?