Remote Pharmacy Contract Auditor & Compliance Analyst

Navitus; Oklahoma City (OK); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off (20 days)

Parental leave (4 weeks)

Paid holidays (9)

401K company match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus program

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 language, and developing controls to ensure adherence and identify root causes of pricing discrepancies.

This position collaborates with the Provider Relations team and other departments, generates reports validating system compliance with contract

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

• Analytical and operational understanding of Navitus’ reimbursement programs including AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, and other pricing structures
• Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, auditors, and internal teams regarding Retail, Specialty, and Mail Order pricing errors with focus on the root cause
• Interpret pharmacy contract language to compare Retail, Specialty, and Mail Order contract pricing to adjudicated claims activity
• Develop and maintain appropriate controls and oversight reporting on the end-to-end process of Retail, Specialty, and Mail Order contract pricing. If process controls are absent, the expectation is to identify, define, and implement new processes as needed
• Responsible for pharmacy network rate testing, chain audits, analysis, and impact assessment
• Make decisions regarding the resolution of pharmacy network pricing setup issues
• Submit service requests, recovery requests, and/or engage applicable teams to make system updates/changes
• Understand, follow, and improve current operational and administrative processes
• Periodic and detailed reporting of contractual compliance activities and opportunities to Provider Services team and cross-functional leadership
• Other duties as assigned

Skills

Analytics experience

Data analysis

Compliance awareness

Teamwork

Education

Bachelor’s degree or equivalent experience

Emphasis in business, finance, economics, or operations preferred

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 language, and developing controls to ensure adherence and identify root causes of pricing discrepancies.

This position collaborates with the Provider Relations team and other departments, generates reports validating system compliance with contract