Remote Pharmacy Contract Audit Analyst

Navitus; Harrisburg (Dauphin County); Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Retirement plan (401K)

Job summary

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will review claims data, develop procedures, and create reports to validate pricing terms.

The role sits in Provider Relations and supports cross-functional teams in ensuring compliance with contracts. The ideal candidate has a bachelor’s degree and at least two years of analytics experience, with strong attention to detail

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 pricing structures.
• Field, analyze, 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 contract pricing end-to-end processes.
• Responsible for network rate testing, chain audits, analysis, and impact assessment.
• Decide on resolution of pricing setup issues.
• Submit service requests and engage teams to update systems.
• Understand, follow, and improve current processes.
• Periodic reporting of contractual compliance activities to Provider Services and leadership.

Skills

Analytical skills

Data analysis

Contract pricing

Root cause analysis

Pricing structures

Education

Bachelor’s degree

Tools

NCRx

PC2

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will review claims data, develop procedures, and create reports to validate pricing terms.

The role sits in Provider Relations and supports cross-functional teams in ensuring compliance with contracts. The ideal candidate has a bachelor’s degree and at least two years of analytics experience, with strong attention to detail