Remote Pharmacy Reimbursement Admin — Remittances

Navitus; Saint Paul (MN); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Parental Leave

Holidays

Retirement Match

Adoption Assistance

FSAs

Education Support

Membership assistance

Referral Bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA partners with providers to review and update claims adjudication procedures, test and review pharmacy networks, and oversee remittances and recoveries.

The role develops reports on reimbursement and remittance activities and ensures compliance with contracts. The position involves independent assessment of Navitus contractual reimbursement obligations and day-to-day tasks such as network updates,

Qualifications

• Associate degree or equivalent experience; CPhT preferred.
• PBM or managed care experience preferred.
• Testing experience preferred.
• Adhere to compliance program objectives.
• Interact cooperatively with colleagues.

Responsibilities

• Administers EFT and remittance setups per policy.
• Provides controls and oversight reporting for end-to-end processes.
• Resolves pharmacy network pricing setup issues and pricing inquiries.
• Develops data import/export processes for Navitus systems.
• Performs network rate testing, analysis and impact assessment.
• Conducts quality assurance to ensure accuracy of network rates.
• Identifies and escalates improper payments and 835 issues.
• Maintains department work instructions and policies.
• Monitors non-compliance related to overpayments and regulations.
• Provides offset detail to pharmacies in recovery projects.
• Oversees financial and metrics reporting, data dictionaries, inquiries and audits.
• Other duties as assigned.

Skills

PBM / managed care

Testing experience

Collaboration / teamwork

Education

Associate degree or equivalent experience

CPhT preferred

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA partners with providers to review and update claims adjudication procedures, test and review pharmacy networks, and oversee remittances and recoveries.

The role develops reports on reimbursement and remittance activities and ensures compliance with contracts. The position involves independent assessment of Navitus contractual reimbursement obligations and day-to-day tasks such as network updates,