Analyst, Tech. Operations Government Programs

Navitus Health Solutions, LLC

Appleton (WI)

On-site

USD 44,000 - 52,000

Full time

7 days ago

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Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Mb

Referral Bonus Program – up to $750!

Job summary

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

The role focuses on executing Government Programs processes accurately and in CMS-compliant fashion, ensuring timely completion and alignment with regulatory guidance. The successful candidate will support EGWP enrollment, FIR, PDE error management, and other related tasks while coordinating with internal teams and external stakeholders to resolve issues and maintain

Qualifications

Bachelor/Associate Degree in business related field required or equivalent
1+ years’ work experience preferred
Experience in pharmaceutical claims adjudication systems, retail pharmacy, or health plan organization preferred
Participate in and support compliance program objectives
Ability to interact cooperatively and respectfully with others

Responsibilities

Execute Government Programs processes accurately and in CMS-compliant manner
Oversee schedules and ensure deadlines are met
Maintain and update process documentation
Assist SMEs in defining steps and requirements for technical specs
Research errors and prioritize reconciliation per state/federal guidance
Communicate with Employer Groups, Clients, Agencies, vendors and Navitus departments to resolve issues
May work outside normal hours for time-sensitive processes
Other duties as assigned

Skills

1+ years’ work experience

Pharmaceutical claims adjudication

Healthcare operations compliance

Effective communication

Education

Bachelor/Associate Degree in business related field

Equivalent combination of education/experience

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 $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?