Analyst, Tech. Operations Government Programs

Navitus; Appleton (WI); On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Health, dental, and vision benefits

PTO 20 days

Parental leave 4 weeks

9 paid holidays

401K company match up to 5%

Adoption assistance

Flexible Spending Account

Education assistance & ProfessionalMEM

Referral bonus up to $750

Job summary

Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team at the Appleton, WI office. This role focuses on executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations.

Responsibilities include overseeing schedules, updating process documentation, and coordinating with employers, clients, and agencies to resolve time-sensitive issues. Commitment to compliance and teamwork is essential.

Qualifications

• Bachelor/Associate Degree in business related field or equivalent experience.
• 1+ years’ work experience.
• Experience in pharmaceutical claims adjudication systems, retail pharmacy, or health plan organization is preferred.
• Participation in compliance program objectives and cooperative teamwork.

Responsibilities

• Execute Government Programs processes in compliance with CMS regulations.
• Oversee process schedules and ensure deadlines are met.
• Update process documentation and assist SMEs with requirements for technical specifications.
• Research errors and prioritize reconciliation per State/Federal guidance.
• Communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to resolve issues.
• May work outside normal hours to complete time-sensitive tasks.
• Other duties as assigned.

Skills

1+ years’ work experience

Education

Bachelor/Associate Degree in business related field

Equivalent of an associate degree with 2 years of work experience

4 years of work experience with high school diploma or equivalent

Job description

Overview

Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team!

The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations.

This role is located out of our Appleton, WI Office

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Assignments may include one or more of the following: Employer Group Waiver Plan (EGWP) enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing
• Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk
• Ensure process documentation accurately reflects the current process and update when necessary
• Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications
• Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance
• Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution
• As needed, may require working outside of normal business hours to complete time sensitive processes
• Other duties as assigned

Qualifications

What our team expects from you?

• Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent
• 1+ years’ work experience
• Experience in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization 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!

#LI-Onsite

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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