Remote Pharmacy Contract Audit Analyst

Navitus; Jefferson City (MO); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

40 days paid time off? (placeholder)

Job summary

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy and ensure compliance with Retail, Specialty, and Mail Order agreements. The role entails reviewing claims data, auditing network pricing, and creating procedures to remediate errors with input from multiple teams.

The analyst will use NCRx and PC2 systems and will generate reports to validate contract terms and performance.

Qualifications

• Bachelor's degree or equivalent experience in business, finance, economics or operations.
• Minimum two years analytics experience.
• Support compliance program objectives.
• Strong cross-functional collaboration.

Responsibilities

• Provide analytics and oversight of pharmacy network reimbursement accuracy.
• Investigate pricing discrepancies in Retail, Specialty, and Mail Order contracts.
• Interpret contract language and compare pricing to adjudicated claims.
• Develop controls and reporting for end-to-end contract pricing processes.
• Test and audit pharmacy network rate setups and pricing.
• Collaborate with teams to resolve system updates/changes.
• Communicate findings to Provider Services and leadership.

Skills

Analytics

Data analysis

Stakeholder communication

Business/Finance/Operations degree (eq

Education

Bachelor's degree in business, finance, economics, or operations

Tools

NCRx

PC2

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy and ensure compliance with Retail, Specialty, and Mail Order agreements. The role entails reviewing claims data, auditing network pricing, and creating procedures to remediate errors with input from multiple teams.

The analyst will use NCRx and PC2 systems and will generate reports to validate contract terms and performance.