Pharmacy Contract Audit Analyst – Remote

Navitus; Hartford (CT); Remote; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus

Zusammenfassung

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order contracts. The role involves reviewing claims data, developing procedures, and auditing networks for price-change accuracy while ensuring compliance with provider contracts and client terms.

The analyst will work with cross-functional teams to interpret contractual terms, utilize NCRx and PC2 systems, and produce reporting

Qualifikationen

• Bachelor’s degree or equivalent experience required in business, finance, economics, or operations.
• 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.

Aufgaben

• Analyze Navitus’ reimbursement programs (AWP, WAC, MAC, NADAC, FUL, AAC) and pricing structures.
• Field, analyze, and resolve inquiries from providers, clients, auditors, and internal teams on pricing errors.
• Interpret contract language to compare contract pricing to adjudicated claims.
• Develop controls and reporting on end-to-end contract pricing along Retail, Specialty, and Mail Order.
• Responsible for network rate testing, chain audits, and impact assessment.
• Make decisions on resolution of pricing setup issues.
• Submit service/recovery requests and coordinate system updates.
• Understand and improve processes.
• Periodic reporting of compliance activities to Provider Services and leadership.
• Other duties as assigned.

Kenntnisse

Analytics experience

Stakeholder communication

Compliance awareness

Ausbildung

Bachelor’s degree or equivalent experience

Jobbeschreibung

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order contracts. The role involves reviewing claims data, developing procedures, and auditing networks for price-change accuracy while ensuring compliance with provider contracts and client terms.

The analyst will work with cross-functional teams to interpret contractual terms, utilize NCRx and PC2 systems, and produce reporting