Remote Pharmacy Reimbursement Administrator

Navitus; Harrisburg (Dauphin County); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health/Dental/Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K match up to 5%

Adoption assistance

Flexible Spending Account

Educational assistance & professional;

Referral bonus program

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA will work with Providers, IT, and others to improve efficiencies in claims adjudication and to review pharmacy networks for contract compliance.

The role includes remittance data accuracy, recoveries, and reporting on reimbursement activities. Remote work options are available, with opportunities to support nationwide operations.

Qualifications

• Associate degree preferred or equivalent experience.
• PBM or managed care experience preferred.
• Previous testing experience preferred.
• Support compliance program objectives.
• Ability to interact cooperatively with colleagues.

Responsibilities

• Administers technical processes for system price setups and remittance setups.
• Maintains controls and oversight reporting on end-to-end processes.
• Resolves pharmacy network pricing setup issues and research inquiries.
• Develops data import/export processes for Navitus systems.
• Tests pharmacy network rates and conducts impact assessments.
• Performs QA to ensure accuracy in network rates.
• identifies and escalates improper payments and 835 issues.
• Maintains detailed work instructions and policies.
• Monitors non-compliance related to overpayments and regulatory issues.
• Provides offset details to pharmacies in recoveries prior to payment.

Skills

PBM experience

Testing experience

Team collaboration

Compliance knowledge

Education

Associate degree or equivalent

CPhT certification preferred

Tools

NCRx

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA will work with Providers, IT, and others to improve efficiencies in claims adjudication and to review pharmacy networks for contract compliance.

The role includes remittance data accuracy, recoveries, and reporting on reimbursement activities. Remote work options are available, with opportunities to support nationwide operations.