Remote Pharmacy Contract Audit Analyst

Navitus; Helena (MT); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health, dental, vision insurance

Paid time off

Parental leave

9 holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to join our Provider Relations team. The role focuses on oversight of contractual pharmacy network reimbursement accuracy, reviewing claims data, and ensuring compliance with Retail, Specialty, and Mail Order agreements.

You will interpret contract language, develop controls, and create reports to validate system accuracy and support network development. This position offers remote work options and comprehensive benefits.

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

• Oversee Navitus’ contract reimbursement accuracy across Retail, Specialty, and Mail Order
• Review claims data and identify root causes of pricing discrepancies
• Interpret contract language to compare contract pricing with adjudicated claims activity
• Develop controls and provide oversight reporting for contract pricing processes
• Conduct network rate testing, chain audits and impact assessment
• Submit service/recovery requests and coordinate system updates with relevant teams
• Communicate findings to applicable stakeholders and drive remediation actions
• Prepare periodic reports on contractual compliance for Provider Services leadership

Skills

Analytics experience

Compliance knowledge

Education

Bachelor’s degree or equivalent experience

Tools

NCRx

PC2

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to join our Provider Relations team. The role focuses on oversight of contractual pharmacy network reimbursement accuracy, reviewing claims data, and ensuring compliance with Retail, Specialty, and Mail Order agreements.

You will interpret contract language, develop controls, and create reports to validate system accuracy and support network development. This position offers remote work options and comprehensive benefits.