Remote Pharmacy Contract Audit Analyst - Compliance

Navitus; Lansing (MI); Remote; USD 65,000 - 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/Mc

Professional Membership assistance

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 across Retail, Specialty, and Mail Order agreements. The role involves reviewing claims data, auditing network price changes, and remediating errors with cross-functional teams using NCRx and PC2 systems.

The Analyst will generate reports validating contract terms and contribute to provider relations initiatives, ensuring compliance and operational efficiency

Qualifications

• Bachelor’s degree or equivalent; business/finance/operations focus preferred.
• Minimum two years analytics experience.
• Commitment to compliance program objectives.
• Ability to interact cooperatively and respectfully with colleagues.

Responsibilities

• Analyze Navitus’ reimbursement programs (AWP, WAC, MAC, NADAC, FUL, AAC, and other pricing structures).
• Field, analyze, and resolve inquiries from providers, clients, auditors, and internal teams regarding pricing errors.
• Interpret contract language to compare pricing to adjudicated claims activity.
• Develop and maintain controls and oversight reporting for contract pricing.
• Responsible for network rate testing, chain audits, and impact assessment.
• Submit service/recovery requests and coordinate system updates.
• Periodic reporting of contractual compliance activities to Provider Services and leadership.

Skills

Analytics experience

Interpersonal skills

Education

Bachelor’s degree or equivalent

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee contractual pharmacy network reimbursement accuracy across Retail, Specialty, and Mail Order agreements. The role involves reviewing claims data, auditing network price changes, and remediating errors with cross-functional teams using NCRx and PC2 systems.

The Analyst will generate reports validating contract terms and contribute to provider relations initiatives, ensuring compliance and operational efficiency