Remote Pharmacy Contract Audit & Compliance Analyst

Navitus; Boston (MA); Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro

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, interpreting contract terms, and developing controls to ensure pricing compliance, while partnering with multiple teams to remediate issues and improve processes.

Qualifications

• 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.

Responsibilities

• Analyze and resolve inquiries from providers, clients, auditors, and internal teams regarding pricing with focus on root cause.
• Interpret contract language to compare contract pricing to adjudicated claims activity.
• Develop and maintain controls and oversight reporting on end-to-end contract pricing processes.
• Responsible for pharmacy network rate testing, audits, and impact assessment.
• Submit service and recovery requests and coordinate system updates as needed.
• Communicate findings and support remediation with applicable teams.

Skills

Analytics

Contract interpretation

Report generation

Cross-functional collaboration

Education

Bachelor’s degree or equivalent experience

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, interpreting contract terms, and developing controls to ensure pricing compliance, while partnering with multiple teams to remediate issues and improve processes.