Reimbursement Analyst, Pharmacy Network

Navitus Health Solutions / Lumicera Health Services; United States; On-site; USD 54,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401K company match

Paid time off (PTO) 20 days

Job summary

Navitus Health Solutions is seeking a Reimbursement Analyst, Pharmacy Network to join our team. The Analyst will support MAC pricing programs, analyze provider agreements, and collaborate with internal and external partners to ensure competitive pricing and compliance.

The role focuses on MAC management, NADAC, state MAC requirements, and responding to pricing inquiries with Navitus guidelines, enabling strong network performance.

Qualifications

• Bachelor’s degree in business, finance, economics, or actuarial science strongly preferred. Recent graduates encouraged to apply.

Responsibilities

• Operate and administer Navitus MAC, NADAC, and pricing structures, updating pricing in Navitus systems.
• Handle inquiries from pharmacy providers, clients, and internal teams.
• Ensure Navitus MAC management complies with state requirements.
• Monitor generic introductions and manage exclusivity timelines.
• Support pricing strategy with analysis of reimbursement activities and industry trends.
• Assist with RFP responses and cross-functional reporting.
• Produce periodic detailed reports to Provider Services leadership.

Education

Bachelor’s degree in business/finance/economics/actuarial science

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 $54,236.00 - USD $64,567.00 /Yr.

STAR Bonus % (At Risk Maximum)

5.00 - Salaried Non-Management except pharmacists

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

M-F;8am-5pm CT

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Navitus Health Solutions is seeking a Reimbursement Analyst, Pharmacy Network to join our team!

The Analyst supports and evaluates agreements with providers and the Maximum Allowable Cost (MAC) program through financial price modeling, analysis, and reporting. This position will communicate and work cross functionally with other teams on generic trends and generic drug discount change effects. Provider and network performance will be analyzed in support of network development, contracting negotiations, and RFP proposals. The Analyst, under the direction and supervision of the Provider Services leadership, is responsible for maintaining a competitive and market leading MAC program. The Analyst will also be responsible for managing and responding to pharmacy pricing inquiries in compliance with Navitus response protocol. This position will help monitor and evaluate state MAC requirements to ensure Navitus remains compliant with MAC management and inquiry. The Analyst will assist in working with internal and external partners including pharmacies, clients, vendors, and internal department liaisons to implement and maintain an effective MAC program.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Operation and timely administration of the Navitus generic pricing programs including MAC, NADAC, or other pricing structures, which includes determining products to be included on the MAC list and the associated price per unit and updating all pricing within Navitus systems.
• Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, and internal teams
• Evaluate state MAC requirements to ensure Navitus MAC management remains compliant.
• Monitor industry events to determine availability of generic introduction to the marketplace and manage exclusivity timeline for newly introduced generics
• Manage consolidation of generic manufacturers in the market that will affect MAC pricing
• Continuously review and pro-actively identify areas of opportunities for pricing and discount performance improvement, including analysis and communication of reimbursement activities
• Research customer and contract issues that may affect account planning, strategies, and proposals. Assists with RFP responses as necessary
• Periodic and detailed reporting of activities and opportunities to Provider Services team and cross-functional leadership
• Research external and internal pricing trends and opportunities to contribute to overall pricing strategy
• Perform analyses as requested by internal and external business owners, or in support of identified business objectives, with special focus on pharmacy network profitability and/or client discounts
• Other duties as assigned

Qualifications

What our team expects from you?

• Bachelor’s degree required. Emphasis in business, finance, economics, or actuarial science strongly preferred. Recent college graduates are encouraged to apply
• 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-Remote

Location : Address

Remote

Location : Country

US