Remote Pharmacy Contract Audit Analyst

Navitus; Madison (WI); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Prof.

Referral Bonus Program

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, interpret contract language, and collaborate with cross-functional teams to remediate discrepancies and improve controls.

The role supports the Provider Relations team in ensuring compliance with contractual terms and reporting on performance metrics.

Qualifications

• Bachelor’s degree or equivalent experience in business, finance, economics, or operations preferred.
• Minimum two years analytics experience required.
• Participate in, adhere to, and support compliance program objectives.
• Ability to interact cooperatively and respectfully with others.

Responsibilities

• Oversee Navitus’ contractual pharmacy network reimbursement accuracy and audit Retail, Specialty, and Mail Order pricing against contracts.
• Review and monitor claims data; create and update procedures; audit networks for price change accuracy.
• Interpret contract language to compare pricing to adjudicated claims activity.
• Develop controls and reporting on end-to-end process of contract pricing; implement new processes as needed.
• Test pharmacy network rates, conduct chain audits, and assess impact of changes.
• Resolve pricing setup issues and engage teams to update systems as needed.
• Produce periodic reports on contractual compliance to Provider Services and leadership.

Skills

Analytics experience

Data analysis

Education

Bachelor’s degree or equivalent experience

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, interpret contract language, and collaborate with cross-functional teams to remediate discrepancies and improve controls.

The role supports the Provider Relations team in ensuring compliance with contractual terms and reporting on performance metrics.