Remote Pharmacy Reimbursement Administrator

Navitus; City of Albany (NY); Remote; USD 60.000 - 85.000; Vollzeit

Benefits dieser Stelle

Health insurance

Paid time off

Parental leave

401K match

Adoption assistance

Education assistance

Referral bonus

Zusammenfassung

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team in a role focused on claims adjudication support, remittance accuracy, and recovery operations via EFT/electronic remittance (835). The PRA collaborates with Provider Relations, IT, and other teams to improve procedures and maintain contractual reimbursement obligations.

The position emphasizes data-driven analysis, network testing, and reporting, with responsibilities spanning pricing setup, remittance

Qualifikationen

• Associate degree or equivalent experience; CPhT preferred.
• PBM or managed care experience preferred.
• Experience with testing and compliance objectives.

Aufgaben

• Administers technical processes for price setups, EFT and remittance setups.
• Ensures controls and oversight reporting for end-to-end processes.
• Resolve pharmacy network pricing setup issues and research inquiries.
• Develops data import/export between Navitus systems and NCRx.
• Responsible for network rate testing, analysis and impact assessments.
• Perform QA to ensure accuracy of network rates and prevent incorrect claims.
• Identify and escalate improper payments and 835 issues.
• Maintain department instructions and policies.
• Monitor non-compliance related to overpayments and regulatory issues.
• Provide offset detail to pharmacies in recovery projects.
• Oversee reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned.

Kenntnisse

Remittance processing

Data analysis

Policy compliance

Interpersonal skills

Ausbildung

Associate Degree

CPhT preferred

Tools

NCRx database

Jobbeschreibung

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team in a role focused on claims adjudication support, remittance accuracy, and recovery operations via EFT/electronic remittance (835). The PRA collaborates with Provider Relations, IT, and other teams to improve procedures and maintain contractual reimbursement obligations.

The position emphasizes data-driven analysis, network testing, and reporting, with responsibilities spanning pricing setup, remittance