Remote Pharmacy Reimbursement Administrator

Navitus; Olympia (WA); Remote; USD 65,000 - 90,000; 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/Mm

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to partner with Provider Relations, IT operations, and other teams to optimize claims adjudication processes. The PRA will monitor remittance activities, ensure data accuracy in EFT/835 remittances, and oversee recoveries from pharmacies.

The role includes testing networks, auditing price changes, and responding to payment inquiries. The ideal candidate will have an Associate degree or equivalent, with CPhT preferred and

Qualifications

• Associate degree or equivalent experience is preferred or required.
• CPhT certification is preferred.
• PBM or managed care experience is preferred but not required.
• Experience participating in and supporting compliance program objectives.
• Ability to interact cooperatively and respectfully with colleagues.

Responsibilities

• Administers technical processes for price setups, EFT and remittance according to policy.
• Implements controls and oversight reporting for end-to-end processes; identifies and adds controls as needed.
• Resolves pricing setup issues; researches pricing inquiries from pharmacies and internal teams.
• Develops processes to import/export data from Navitus systems (e.g., NCRx, Pharmacy Credential and Contracting).
• Performs network rate testing, analysis and impact assessment.
• Conducts quality assurance to ensure accuracy in network rates and prevent incorrect claims adjudication.
• Identifies and escalates improper payments and 835 issues.
• Maintains department work instructions and policies.
• Monitors and reports non-compliance related to overpayments and financial regulations.
• Provides offset details to pharmacies in recovery projects prior to payment and remittance.
• Oversees financial and metrics reporting, data dictionaries, inquiries and audits.
• Performs other duties as assigned.

Skills

Interpersonal skills

Compliance awareness

Testing experience

Team collaboration

Education

Associate degree or equivalent experience

CPhT preferred

Job description

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to partner with Provider Relations, IT operations, and other teams to optimize claims adjudication processes. The PRA will monitor remittance activities, ensure data accuracy in EFT/835 remittances, and oversee recoveries from pharmacies.

The role includes testing networks, auditing price changes, and responding to payment inquiries. The ideal candidate will have an Associate degree or equivalent, with CPhT preferred and