Remote Pharmacy Contract Audit Analyst

Navitus; Salem (OR); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Holidays

401k match

Adoption assistance

Flexible Spending Account

Education assistance

Professional membership assistance

Referral bonus

Job summary

Navitus Health Solutions seeks an Analyst, Pharmacy Contract Audit to join the Provider Relations team. The role oversees contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order contracts, interpreting pricing structures and contract language for compliance.

The analyst will review claims data, develop controls and reporting, conduct network rate testing, and collaborate with cross-functional teams to remediate issues and ensure adherence to contractual terms.

Qualifications

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

Responsibilities

• Analyze Navitus' reimbursement programs (AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, etc.).
• Field, analyze, and resolve inquiries from providers, clients, auditors, and internal teams regarding pricing errors.
• Interpret contract language to compare contract pricing to adjudicated claims activity.
• Develop and maintain controls and oversight reporting for Retail, Specialty, and Mail Order pricing processes.
• Perform pharmacy network rate testing, chain audits, and impact assessment.
• Submit service/recovery requests and engage teams to implement system updates.

Skills

Analytics

Contract auditing

Pricing knowledge

Compliance

Education

Bachelor's degree

Tools

NCRx

PC2

Job description

Navitus Health Solutions seeks an Analyst, Pharmacy Contract Audit to join the Provider Relations team. The role oversees contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order contracts, interpreting pricing structures and contract language for compliance.

The analyst will review claims data, develop controls and reporting, conduct network rate testing, and collaborate with cross-functional teams to remediate issues and ensure adherence to contractual terms.