Remote Pharmacy Contract Audit Analyst

Lonestar State College; Little Rock (AR); Remote; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave 4 weeks

9 paid holidays

401K company match up to 5%

Adoption Assistance

Flexible Spending Account

Education & Professional Membership

Referral Bonus Program

Job summary

Navitus Health Solutions seeks an Analyst, Pharmacy Contract Audit to oversee contractual network reimbursement accuracy across Retail, Specialty, and Mail Order. The role involves reviewing claims data, interpreting contract terms, and creating procedures to ensure compliance and system integrity using NCRx and PC2.

The ideal candidate has a bachelor’s degree and at least two years of analytics experience, with a focus on pricing structures and cross-team collaboration.

Qualifications

• Bachelor's degree or equivalent experience
• Minimum two years analytics experience
• Participate in, adhere to, and support compliance program objectives
• Ability to interact cooperatively and respectfully with other employees

Responsibilities

• Analyze reimbursement programs including AWP, WAC, MAC, NADAC, FUL and other pricing structures
• Field, analyze, and resolve inquiries regarding Retail, Specialty, and Mail Order pricing errors focusing on root cause
• Interpret contract language to compare pricing to adjudicated claims activity
• Develop and maintain controls and oversight reporting for contract pricing processes
• Test and audit pharmacy network rates and performance, assess impact of changes
• Decide on resolution of pricing setup issues within the network
• Submit service or recovery requests and coordinate system updates
• Understand and improve current operational processes
• Periodically report contractual compliance activities to Provider Services and leadership
• Other duties as assigned

Skills

Analytics experience

Communication

Education

Bachelor's degree

Tools

NCRx adjudication system

PC2 database

Job description

Navitus Health Solutions seeks an Analyst, Pharmacy Contract Audit to oversee contractual network reimbursement accuracy across Retail, Specialty, and Mail Order. The role involves reviewing claims data, interpreting contract terms, and creating procedures to ensure compliance and system integrity using NCRx and PC2.

The ideal candidate has a bachelor’s degree and at least two years of analytics experience, with a focus on pricing structures and cross-team collaboration.