Remote Pharmacy Reimbursement Administrator

Navitus; Lansing (MI); Remote; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro-Mf

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions in Michigan seeks a Pharmacy Reimbursement Administrator to optimize claims adjudication, review networks, and manage remittances and recoveries. The role involves testing networks, auditing price changes, and ensuring adherence to Navitus contracts.

You will collaborate with Provider Relations, IT and other teams to generate reports, monitor compliance, and support financial controls.

Qualifications

• Associate Degree preferred or equivalent experience.
• CPhT preferred.
• PBM or managed care knowledge is preferred but not required.
• Participate in, adhere to, and support compliance program objectives.
• Ability to interact cooperatively and respectfully with others.

Responsibilities

• Administers technical processes in support of price setups, EFT and remittance setups.
• Ensures controls and oversight reporting on end-to-end process.
• Resolve pharmacy network pricing setup issues and research inquiries.
• Develop processes to import/export data from Navitus systems, including NCRx.
• Responsible for network rate testing, analysis and impact assessment.
• Perform QA to ensure accuracy in network rates to prevent incorrect claims.
• Identify and elevate improper payments and 835 issues.
• Maintain department work instructions and policies.
• Monitor and report non-compliance relating to overpayments and regulatory issues.
• Provide offset details to pharmacies in recovery projects.
• Oversee financial and metric reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned.

Skills

Associate Degree

CPhT preferred

PBM knowledge

Testing experience

Compliance

Communication

Education

Associate Degree or equivalent

CPhT preferred

Tools

NCRx database

Pricing systems

Job description

Navitus Health Solutions in Michigan seeks a Pharmacy Reimbursement Administrator to optimize claims adjudication, review networks, and manage remittances and recoveries. The role involves testing networks, auditing price changes, and ensuring adherence to Navitus contracts.

You will collaborate with Provider Relations, IT and other teams to generate reports, monitor compliance, and support financial controls.