Remote Pharmacy Reimbursement Admin – Claims & Remittance

Navitus; Phoenix (AZ); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K match

Job summary

Navitus Health Solutions is hiring a Pharmacy Reimbursement Administrator to partner with Provider Relations, IT, and others to optimize claims adjudication and remittance processes. You will test pharmacy networks, manage EFTs and 835 remittances, and drive recoveries and reporting across reimbursement activities.

The role requires independent assessment to ensure Navitus complies with contractual reimbursement obligations and supports ongoing price and network accuracy.

Qualifications

• Associate Degree preferred or equivalent experience. CPhT preferred.
• PBM or managed care is preferred, but not required.
• Previous testing experience is preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

• Administers technical processes in support of system price setups, EFT and remittance setups according to policy.
• Ensures appropriate controls and oversight reporting on the end-to-end process.
• Make decisions regarding resolution of pharmacy network pricing setup issues.
• Develop processes to import/export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx.
• Responsible for pharmacy network rate testing, analysis and impact assessment.
• Perform quality assurance to ensure accuracy in pharmacy network rates.
• Identify and elevate improper payments and 835 issues.
• Maintenance of department work instructions and policies.
• Monitor and report non-compliance relating to overpayments and regulatory issues.
• Provide offset detail to pharmacies in a recovery project prior to receipt of payment and remittance.
• Oversee applicable financial and metric reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned.

Skills

Pharmacy reimbursement

Claims processing

Network testing

Data analysis

Regulatory compliance

Education

Associate degree

CPhT preferred

Tools

NCRx

EFT setup

Job description

Navitus Health Solutions is hiring a Pharmacy Reimbursement Administrator to partner with Provider Relations, IT, and others to optimize claims adjudication and remittance processes. You will test pharmacy networks, manage EFTs and 835 remittances, and drive recoveries and reporting across reimbursement activities.

The role requires independent assessment to ensure Navitus complies with contractual reimbursement obligations and supports ongoing price and network accuracy.