Remote Pharmacy Contract Audit Analyst

Navitus; Washington (District of Columbia); A distancia; USD 65.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

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.

Referral Bonus Program - up to $750

Descripción de la vacante

Navitus Health Solutions seeks an Analyst, Pharmacy Contract Audit to oversee contractual network reimbursement accuracy across Retail, Specialty, and Mail Order programs. The role involves analysing claims data, identifying pricing discrepancies, and remediating issues in collaboration with cross-functional teams.

You will develop controls, produce compliance reports, and monitor pricing adherence while supporting Navitus' provider contracts and operational workflows in a remote setting.

Formación

• Bachelor's degree or equivalent experience required. Emphasis in business, finance, economics, or operations preferred.
• Minimum two years analytics experience required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsabilidades

• Oversight of contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order programs.
• Field inquiries regarding pricing errors and investigate root causes.
• Interpret contract language and compare pricing to adjudicated activity.
• Develop and maintain controls and reporting for end-to-end pricing processes.
• Conduct network rate testing, chain audits, and impact assessments.
• Resolve pharmacy network pricing setup issues.
• Submit service or recovery requests and coordinate system updates.
• Follow and improve operational processes.
• Provide periodic, detailed reporting of contractual compliance to leadership.

Conocimientos

Analytics experience

Compliance

Interpersonal communication

Problem-solving

Educación

Bachelor's degree or equivalent experience

Descripción del empleo

Navitus Health Solutions seeks an Analyst, Pharmacy Contract Audit to oversee contractual network reimbursement accuracy across Retail, Specialty, and Mail Order programs. The role involves analysing claims data, identifying pricing discrepancies, and remediating issues in collaboration with cross-functional teams.

You will develop controls, produce compliance reports, and monitor pricing adherence while supporting Navitus' provider contracts and operational workflows in a remote setting.