Remote Pharmacy Contract Audit Specialist

Navitus; Sacramento (CA); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

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 interpret contract terms, audit pricing, and create reports to validate system accuracy and compliance. The role involves cross-functional collaboration and process improvement within the Provider Relations team.

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 pricing structures across Retail, Specialty, and Mail Order programs.
• Field and resolve inquiries about pricing errors with root-cause focus.
• Interpret contract language to compare pricing to adjudicated claims.
• Develop controls and reporting for end-to-end pricing processes.
• Test pharmacy network rate setups and perform audits.
• Resolve network pricing setup issues and implement changes.
• Submit service or recovery requests and coordinate system updates.

Skills

Analytics

Contract auditing

Interdepartmental collaboration

Data interpretation

Education

Bachelor’s degree or equivalent experience

Tools

NCRx

PC2

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 interpret contract terms, audit pricing, and create reports to validate system accuracy and compliance. The role involves cross-functional collaboration and process improvement within the Provider Relations team.