Remote Pharmacy Reimbursement Administrator

Navitus; Tallahassee (FL); Remote; USD 65,000 - 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 company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Proff.

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to join our team, focusing on claims adjudication, EFT/remittance setup, and recovery reporting. The role collaborates with Provider Relations, IT, and others to ensure contract compliance and accurate data handling.

The ideal candidate has an Associate degree or equivalent, with CPhT preferred and PBM/managed care exposure. Navitus offers a remote-friendly environment and comprehensive benefits.

Qualifications

• Associate Degree preferred or equivalent experience. CPhT preferred.
• PBM or managed care is preferred, but not required.
• Previous testing experience is 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.
• Make decisions regarding the resolution of pharmacy network pricing setup issues.
• 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 escalated 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

Attention to detail

Compliance awareness

Team collaboration

Communication

Testing experience

Education

Associate degree or equivalent

CPhT certification (preferred)

Job description

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to join our team, focusing on claims adjudication, EFT/remittance setup, and recovery reporting. The role collaborates with Provider Relations, IT, and others to ensure contract compliance and accurate data handling.

The ideal candidate has an Associate degree or equivalent, with CPhT preferred and PBM/managed care exposure. Navitus offers a remote-friendly environment and comprehensive benefits.