Remote Pharmacy Contract Audit Analyst

Navitus; Olympia (WA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Mf

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy. You will review claims data, interpret contract terms, and create procedures to ensure compliance with Retail, Specialty, and Mail Order agreements.

The role collaborates with multiple teams to remediate errors and improve processes. The position requires at least a bachelor’s degree or equivalent and a minimum of two years of analytics experience, with strong

Qualifications

• Bachelor’s degree or equivalent experience; emphasis in business, finance, economics, or operations preferred.
• Minimum two years analytics experience.
• 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 AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, and other pricing structures
• Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, auditors, and internal teams regarding Retail, Specialty, and Mail Order pricing errors with focus on the root cause
• Interpret pharmacy contract language to compare Retail, Specialty, and Mail Order contract pricing to adjudicated claims activity
• Develop and maintain appropriate controls and oversight reporting on the end-to-end process of Retail, Specialty, and Mail Order contract pricing. If process controls are absent, the expectation is to identify, define, and implement new processes as needed
• Responsible for pharmacy network rate testing, chain audits, analysis, and impact assessment
• Make decisions regarding the resolution of pharmacy network pricing setup issues
• Submit service requests, recovery requests, and/or engage applicable teams to make system updates/changes
• Understand, follow, and improve current operational and administrative processes
• Periodic and detailed reporting of contractual compliance activities and opportunities to Provider Services team and cross-functional leadership
• Other duties as assigned

Skills

Analytical skills

Data analysis

Root cause analysis

Stakeholder communication

Education

Bachelor’s degree or equivalent

Business/Finance/Economics/Operations emphasis

Tools

NCRx system

PC2

Contracting databases

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy. You will review claims data, interpret contract terms, and create procedures to ensure compliance with Retail, Specialty, and Mail Order agreements.

The role collaborates with multiple teams to remediate errors and improve processes. The position requires at least a bachelor’s degree or equivalent and a minimum of two years of analytics experience, with strong