Remote Pharmacy Contract Audit Specialist

ISHE; Boise (ID); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/fi

Referral Bonus Program up to $750

Job summary

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee the contract reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will review claims data, audit price changes, monitor compliance with provider contracts, and report findings to cross-functional teams.

The role supports the Provider Relations team, working with NCRx and PC2 systems to validate contractual terms and drive remediation of errors.

Qualifications

• Bachelor's degree or equivalent experience required.
• 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 pricing inquiries from providers, clients, auditors, and internal teams focusing on root causes.
• Interpret contract language to compare pricing to adjudicated claims activity.
• Develop and maintain controls and oversight reporting for end-to-end contract pricing across Retail, Specialty, and Mail Order.
• Test pharmacy network rates, conduct chain audits, and assess impact of changes.
• Submit service or recovery requests and coordinate system updates as needed.
• Follow and improve current operational processes; share results with Provider Services and leadership.

Skills

Analytics

Communication

Education

Bachelor's degree or equivalent experience

Job description

Navitus Health Solutions is seeking an Analyst, Pharmacy Contract Audit to oversee the contract reimbursement accuracy across Retail, Specialty, and Mail Order networks. You will review claims data, audit price changes, monitor compliance with provider contracts, and report findings to cross-functional teams.

The role supports the Provider Relations team, working with NCRx and PC2 systems to validate contractual terms and drive remediation of errors.