Remote Pharmacy Reimbursement Administrator

Navitus; Trenton (NJ); Remote; USD 70,000 - 95,000; 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

Flexible Spending Account

Education assistance & professional会员

Referral bonus up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA collaborates across Provider Relations, IT, and others to review procedures, test networks, and ensure claims adjudication aligns with pharmacy contracts.

You will manage remittances, EFT data accuracy, and recoveries, while generating reports on reimbursement and remittance activities. The role emphasizes independent assessment to ensure Navitus adheres to contractual reimbursement obligations,

Qualifications

• Associate Degree preferred or equivalent experience.
• PBM or managed care experience preferred.
• Testing experience preferred.
• Support compliance program objectives.

Responsibilities

• Support system price setups, EFT and remittance setups per policy.
• Maintain controls and provide end-to-end process oversight.
• Resolve pricing setup issues and respond to pricing inquiries.
• Import/export data between Navitus systems and NCRx.
• Test pharmacy network rates and assess impact on claims.
• Perform QA to ensure accuracy of network rates.
• Identify improper payments and 835 issues.
• Maintain work instructions and policies.
• Report non-compliance and overpayments; assist remittance.
• Provide offset details to pharmacies in recoveries.

Skills

Associate Degree

PBM experience

Testing experience

Interpersonal skills

Education

Associate Degree preferred or equivalent

Tools

NCRx database

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA collaborates across Provider Relations, IT, and others to review procedures, test networks, and ensure claims adjudication aligns with pharmacy contracts.

You will manage remittances, EFT data accuracy, and recoveries, while generating reports on reimbursement and remittance activities. The role emphasizes independent assessment to ensure Navitus adheres to contractual reimbursement obligations,