Remote Pharmacy Reimbursement Specialist

Navitus; Atlanta (GA); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health/Dental/Vision

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

FSAs

Education allowance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team in Atlanta, GA. You will partner with Provider Relations, IT, and others to review procedures and ensure claims adjudicate per contracts.

The role covers remittances, EFTs, 835 remittance advice, and recoveries from pharmacies, with emphasis on accuracy and compliance. Ideal candidates have an associate degree or equivalent, PBM/managed care exposure, and testing experience.

Qualifications

• Associate degree or equivalent experience; CPhT preferred.
• PBM or managed care experience preferred.
• Testing experience preferred.
• Strong compliance orientation and teamwork.

Responsibilities

• Administers price setup, EFT and remittance processes per policy.
• Maintains controls and oversight reporting for end-to-end process.
• Resolves pricing setup issues; researches pharmacy inquiries.
• Develops data import/export processes in Navitus systems.
• Tests pharmacy network rates and assesses impact.
• Monitors non-compliance and overpayments; supports recoveries.
• Provides offset details to pharmacies prior to payment remittance.

Skills

Attention to detail

Analytical thinking

Teamwork

Communication skills

Education

Associate degree or equivalent

CPhT preferred

Tools

NCRx

Pharmacy Credential & Contracting database

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team in Atlanta, GA. You will partner with Provider Relations, IT, and others to review procedures and ensure claims adjudicate per contracts.

The role covers remittances, EFTs, 835 remittance advice, and recoveries from pharmacies, with emphasis on accuracy and compliance. Ideal candidates have an associate degree or equivalent, PBM/managed care exposure, and testing experience.