Remote Pharmacy Reimbursement Administrator

Navitus; Nashville (TN); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health Insurance

Paid time off 20 days

Parental leave 4 weeks

9 paid holidays

401K company match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. This role partners with Provider Relations, IT Client Operations, and others to review and update procedures for claims adjudication, test networks, and remittance accuracy, including EFT and 835 remittance processes.

You will also oversee recoveries from pharmacies and generate reports on reimbursement activities. The PRA will audit networks for price changes, respond to payment questions, set up

Qualifications

• Associate Degree preferred or equivalent experience; CPhT preferred.
• PBM or managed care experience preferred.
• Previous testing experience 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, electronic funds transfer and remittance setups according to policy.
• Ensures appropriate controls and oversight reporting on the end-to-end process. If process controls are absent, identify, define, and implement new ones as needed.
• Make decisions regarding the resolution of pharmacy network pricing setup issues. Research pricing inquiries from pharmacies and internal teams.
• Develop processes to import and 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 on an ongoing basis to mitigate the risk of incorrect claims adjudication.
• Appropriately identify and elevate improper payments and 835 issues.
• Maintenance of department detail work instructions and policies.
• Monitoring and reporting of non-compliance relating to overpayments, transaction standard issues and financial regulations.
• Provide offset detail to pharmacies impacted in a recovery project prior to receipt of payment and remit.
• Responsible for oversight of applicable financial and metric’s reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned

Skills

Associate degree/equivalent

CPhT

PBM/managed care

Testing experience

Compliance awareness

Team collaboration

Education

Associate degree or equivalent experience

CPhT certification preferred

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. This role partners with Provider Relations, IT Client Operations, and others to review and update procedures for claims adjudication, test networks, and remittance accuracy, including EFT and 835 remittance processes.

You will also oversee recoveries from pharmacies and generate reports on reimbursement activities. The PRA will audit networks for price changes, respond to payment questions, set up