Remote Pharmacy Reimbursement Specialist

Navitus; Annapolis (MD); Remote; USD 65.000 - 95.000; Vollzeit

Benefits dieser Stelle

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 Program

Flexible Spending Account

Educational Assistance Plan & Prof./M‑

Referral Bonus Program up to $750

Zusammenfassung

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator who partners with Provider Relations, IT operations, and others to optimize claims adjudication processes and ensure adherence to pharmacy contract agreements.

The PRA handles remittances, EFT data accuracy, 835 remittance, and recoveries from pharmacies. Includes testing network updates, auditing pricing changes, and reporting reimbursement activities.

Qualifikationen

• Associate Degree preferred or equivalent experience.
• CPhT preferred.
• PBM or managed care experience preferred.
• Participate in and support compliance program objectives.
• Ability to interact cooperatively and respectfully with others.

Aufgaben

• Administers technical processes for system price setups, EFT and remittance according to policy.
• Maintains appropriate controls and oversight reporting on end-to-end processes; identifies and implements new controls when needed.
• Resolves pharmacy network pricing setup issues and researches pricing inquiries from pharmacies and internal teams.
• Develops processes to import and export data from Navitus systems and databases (e.g., Pharmacy Credential and Contracting, NCRx).
• Responsible for pharmacy network rate testing, analysis and impact assessment.
• Performs QA to ensure accuracy in pharmacy network rates and reduce incorrect claims adjudication risk.
• Identifies and escalates improper payments and 835 issues.
• Maintains department work instructions and policies.
• Monitors non-compliance relating to overpayments and regulatory issues.
• Provides offset detail to pharmacies in recoveries prior to payment/remittance.
• Oversees financial and metric reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned.

Kenntnisse

Previous testing experience

Compliance awareness

Interpersonal skills

Ausbildung

Associate Degree or equivalent

CPhT preferred

Jobbeschreibung

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator who partners with Provider Relations, IT operations, and others to optimize claims adjudication processes and ensure adherence to pharmacy contract agreements.

The PRA handles remittances, EFT data accuracy, 835 remittance, and recoveries from pharmacies. Includes testing network updates, auditing pricing changes, and reporting reimbursement activities.