Remote Pharmacy Reimbursement Analyst

Navitus; Madison (WI); Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

9 holidays

401K match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA collaborates with Provider Relations, IT Client Operations, and others to improve claims adjudication processes and ensure adherence to Navitus contracts.

The role handles pharmacy remittances, EFTs and 835 remittance data, conducts rate testing, and prepares reports on reimbursement, recovery, and remittance activities. Remote-friendly position with strong compliance focus.

Qualifications

• Associate degree or equivalent experience is preferred.
• CPhT certification is a plus.
• Experience with PBM or managed care is preferred.
• Previous testing experience is beneficial.
• Ability to participate in and support compliance objectives.

Responsibilities

• Administers technical processes for price setups, EFTs and remittance setups per policy.
• Ensures controls and oversight reporting on end-to-end processes; develops new controls as needed.
• Resolves pharmacy network pricing setup issues; researches pricing inquiries.
• Develops processes to import/export data from Navitus systems.
• Tests network rates and assesses impact on claims.
• Performs QA to ensure accuracy of network rates and mitigate mis-adjudication risk.
• Identifies and flags improper payments and 835 issues.
• Maintains department work instructions and policies.
• Monitors non-compliance related to overpayments and financial regulations.
• Provides offset detail to pharmacies in recovery projects before payment.
• Oversees financial and metric reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned.

Skills

PBM knowledge

Testing experience

Teamwork

Compliance awareness

Pricing/claims understanding

Education

Associate Degree or equivalent experience

CPhT preferred

Tools

NCRx

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA collaborates with Provider Relations, IT Client Operations, and others to improve claims adjudication processes and ensure adherence to Navitus contracts.

The role handles pharmacy remittances, EFTs and 835 remittance data, conducts rate testing, and prepares reports on reimbursement, recovery, and remittance activities. Remote-friendly position with strong compliance focus.