Remote Pharmacy Reimbursement Analyst

Navitus; Denver (CO); Remote; USD 65,000 - 85,000; 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 Pro/Mb

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. You will work with Provider Relations, IT Client Operations, and others to review and update procedures to improve claims adjudication efficiency.

The PRA will test and review pharmacy networks to ensure that claims adjudicate per Navitus contract agreements. You will manage remittances, EFTs, and 835-remittance advice, and provide reports on reimbursement, recovery, and remittance activities.

Qualifications

• Associate degree or equivalent experience required or preferred; CPhT preferred.
• PBM or managed care experience preferred but not required.
• Testing experience is preferred to support QA efforts.
• Participate in compliance program objectives and maintain professional conduct.
• Ability to collaborate effectively with colleagues and teams.

Responsibilities

• Administers price setups, EFT and remittance processes according to policy.
• Ensures controls and oversight reporting for end-to-end processes; identifies gaps.
• Resolves pharmacy network pricing setup issues and researches inquiries.
• Develops data import/export processes for Navitus systems (NCRx, Credential/Contracting).
• Performs pharmacy network rate testing and impact assessment.
• Conducts QA to ensure accuracy of network rates and prevent incorrect claims.
• Elevates improper payments and 835 issues for corrective action.
• Maintains work instructions and departmental policies.

Skills

Associate degree or equivalent

Testing experience

Compliance

Team collaboration

Education

Associate degree or equivalent experience

CPhT certification

Tools

NCRx database

Pharmacy Credential and Contracting database

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. You will work with Provider Relations, IT Client Operations, and others to review and update procedures to improve claims adjudication efficiency.

The PRA will test and review pharmacy networks to ensure that claims adjudicate per Navitus contract agreements. You will manage remittances, EFTs, and 835-remittance advice, and provide reports on reimbursement, recovery, and remittance activities.