Analyst, Tech. Operations Government Programs

Navitus Health Solutions; Appleton (WI); On-site; USD 44,000 - 52,000; Full time

Benefits offered by this job

Health, Dental and Vision insurance

PTO 20 days

Parental leave 4 weeks

9 paid holidays

401K match up to 5%

Adoption assistance

Flexible Spending Account

Education & Membership assistance

Referral bonus up to $750

Job summary

Navitus Health Solutions in Appleton, WI is seeking an Analyst, Tech. Operations Government Programs to ensure government program processes are executed accurately and in compliance with CMS rules.

This role is based in our Appleton office and involves cross‑functional collaboration with internal teams and external partners to resolve issues and improve processes. The position requires a bachelor or equivalent and at least 1 year of experience, with preference for candidates familiar with

Qualifications

• 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 (preferred)
• Experience in pharmaceutical claims adjudication systems, retail pharmacy, or health plan organization (preferred)

Responsibilities

• Enrollment administration and oversight for EGWP, retro-eligibility processes, FIR, Plan Finder submissions, COB, PDE error management and reconciliation.
• Oversee schedules and ensure deadlines; escalate when at risk
• Update process documentation to reflect current steps and requirements
• Assist SMEs in documenting requirements for technical specs
• Research errors and prioritize reconciliation in line with guidance
• Communicate with Employer Groups, Clients, Agencies, vendors and Navitus departments to resolve issues promptly
• May require working outside normal hours to complete time-sensitive processes
• Other duties as assigned

Education

Bachelor/Associate Degree or equivalent

Job description

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 $43,780.00 - USD $52,119.00 /Yr.

STAR Bonus % (At Risk Maximum)

7.50 - Salaried Non-Management except pharmacists

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

M-F 8am to 5pm

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!

Location

Address: 1025 West Navitus Dr.

City: Appleton

State/Province: WI

Postal Code: 54913

Country: US