Remote Pharmacy Reimbursement Administrator

Navitus; Washington (District of Columbia); Remote; USD 65,000 - 86,000; Full time

Benefits offered by this job

Health insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K matching

Adoption aid

FSAs

Education assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA partners with Provider Relations, IT Client Operations and others to review and update procedures for efficient claims adjudication.

This role tests and reviews pharmacy networks to ensure claims adjudication aligns with Navitus contracts, manages remittances and EFT data, and provides reports on reimbursement, recovery and remittance activities. Remote work is available.

Qualifications

• Associate degree preferred or equivalent experience.
• CPhT preferred.
• PBM or managed care experience preferred.
• Testing experience preferred.
• Adhere to compliance program objectives.
• Collaborate respectfully with colleagues.

Responsibilities

• Administers price setups, EFT and remittance setups according to policy.
• Maintains controls and oversight reporting for the end-to-end process.
• Decides on resolution of network pricing setup issues; researches inquiries.
• Develops data import/export between Navitus systems (NCRx, Credential and Contracting).
• Tests pharmacy network rates and assesses impact.
• Performs QA to ensure accuracy of network rates to prevent incorrect claims.
• Identifies and escalates improper payments and 835 issues.
• Maintains department work instructions and policies.
• Monitors non-compliance related to overpayments and financial regulations.
• Provides offset details to pharmacies in recovery projects.
• Oversees financial and metrics reporting, data dictionaries, inquiries, audits.
• Other duties as assigned.

Skills

Detail oriented

Analytical thinking

Education

Associate degree or equivalent

CPhT preferred

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA partners with Provider Relations, IT Client Operations and others to review and update procedures for efficient claims adjudication.

This role tests and reviews pharmacy networks to ensure claims adjudication aligns with Navitus contracts, manages remittances and EFT data, and provides reports on reimbursement, recovery and remittance activities. Remote work is available.