Pharmacy Contract Audit Analyst — Data-Driven Compliance

Navitus; Dover (DE); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/M_

Job summary

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to join the Provider Relations team in Dover, DE. The role oversees contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks, reviews claims data, and develops controls and reports to validate compliance with contract terms.

Responsibilities include testing pricing setups, addressing inquiries from providers and clients, interpreting contract language, and delivering periodic reports to

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 AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, and other pricing structures.
• Field and resolve inquiries from providers, clients, auditors, and internal teams regarding pricing errors with focus on root cause.
• Interpret contract language to compare contract pricing to adjudicated claims activity.
• Develop and maintain controls and oversight reporting on end-to-end contract pricing processes.
• Responsible for pharmacy network rate testing, chain audits, analysis, and impact assessment.
• Make decisions regarding the resolution of pricing setup issues.
• Submit service or recovery requests and coordinate system updates.

Skills

Analytics experience

Interpersonal skills

Education

Bachelor’s degree or equivalent experience

Tools

NCRx

PC2

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to join the Provider Relations team in Dover, DE. The role oversees contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks, reviews claims data, and develops controls and reports to validate compliance with contract terms.

Responsibilities include testing pricing setups, addressing inquiries from providers and clients, interpreting contract language, and delivering periodic reports to