Remote Pharmacy Contract Audit Analyst

Navitus; City of Albany (NY); Remote; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Health Insurance

Dental & Vision

Paid Time Off

Parental Leave

9 Holidays

401K Match

Adoption Support

FSAs

Education Assistance

Referral Bonus

Zusammenfassung

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to ensure contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will analyze claims data, interpret contract language, and develop controls to support compliance and quality reporting.

This role sits in the Provider Relations team, working remotely with access to Navitus' NCRx and PC2 systems, and reporting findings to cross-functional leadership.

Qualifikationen

• Bachelor's degree or equivalent experience required; emphasis in business, finance, economics, or operations preferred.
• Minimum two years analytics experience required.
• Must participate in and support compliance program objectives.

Aufgaben

• Oversee contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order.
• Review claims data, interpret contract terms, and assess pricing against adjudicated activity.
• Develop controls and reporting for end-to-end contract pricing processes.
• Perform network rate testing, chain audits, and impact assessments.
• Respond to inquiries from providers, clients, auditors, and internal teams; resolve pricing errors.
• Produce reports to validate system accuracy against contractual terms.

Kenntnisse

Analytics

Detail-oriented

Ausbildung

Bachelor's degree or equivalent experience

Tools

NCRx system

PC2 database

Jobbeschreibung

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to ensure contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will analyze claims data, interpret contract language, and develop controls to support compliance and quality reporting.

This role sits in the Provider Relations team, working remotely with access to Navitus' NCRx and PC2 systems, and reporting findings to cross-functional leadership.