Remote Pharmacy Contract Audit Analyst

Navitus; Topeka (KS); Remote; USD 60,000 - 85,000; 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 of up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro. d

Referral Bonus Program – up to $750

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 terms, and produce reports to validate pricing against contracts.

You’ll work with the Provider Relations team to remediate errors, develop controls, and support compliance programs while using NCRx and PC2 and other systems to monitor network performance.

Qualifications

• Bachelor’s degree or equivalent experience; emphasis in business, finance, economics, or operations preferred.
• Minimum two years analytics experience required.
• Support compliance program objectives.
• Ability to interact cooperatively and respectfully with other employees.

Responsibilities

• Analyze Navitus reimbursement programs including AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, and other pricing structures.
• Field, analyze, and resolve inquiries about pricing errors with focus on root cause.
• Interpret contract language to compare pricing to adjudicated claims activity.
• Develop and maintain controls and oversight reporting for end-to-end contract pricing.
• Test pharmacy network rates, perform chain audits, and assess impact.
• Decide on resolution of pricing setup issues.
• Submit service/recovery requests and coordinate system updates.
• Understand, follow, and improve current processes.
• Provide periodic reporting of contractual compliance to Provider Services and leadership.

Skills

Analytical skills

Data analysis

Communication

Teamwork

Education

Bachelor’s degree or equivalent

Tools

NCRx system

PC2 database

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 terms, and produce reports to validate pricing against contracts.

You’ll work with the Provider Relations team to remediate errors, develop controls, and support compliance programs while using NCRx and PC2 and other systems to monitor network performance.