Remote Pharmacy Reimbursement Specialist

Navitus; Hartford (CT); Teletrabalho; USD 65 000 - 90 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K match

Adoption assistance

FSA

Education assistance

Referral bonus

Resumo da oferta

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA collaborates with provider relations, IT, and others to refine procedures for claims adjudication and remittance processing.

Daily tasks include testing pharmacy networks, monitoring remittances, and recovering funds from negative balances, while ensuring adherence to contracts. The role emphasizes independent assessment to confirm Navitus is meeting contractual reimbursement obligations and

Qualificações

• Associate degree or equivalent experience. CPhT preferred.
• PBM or managed care experience is preferred, but not required.
• Previous testing experience is preferred.
• Support compliance program objectives.
• Ability to interact cooperatively with others.

Responsabilidades

• Administers technical processes for system price setups, EFT and remittance setups according to policy.
• Provides controls and oversight reporting for end-to-end processes; identifies and implements new controls as needed.
• Resolves pharmacy network pricing setup issues; researches pricing inquiries from pharmacies and internal teams.
• Develops data import/export processes between Navitus systems including NCRx.
• Responsible for pharmacy network rate testing, analysis and impact assessment.
• Performs QA to ensure accuracy in pharmacy network rates and prevent incorrect claims.
• Identifies improper payments and 835 issues for escalation.
• Maintains department work instructions and policies.
• Monitors non-compliance related to overpayments and regulatory requirements.
• Provides offset details to pharmacies in recovery projects and remittance processing.
• Oversees financial and metric reporting, data dictionaries, inquiries, and audits.
• Other duties as assigned.

Conhecimentos

Testing experience

Cooperative work style

Formação académica

Associate degree or equivalent

CPhT preferred

Descrição da oferta de emprego

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA collaborates with provider relations, IT, and others to refine procedures for claims adjudication and remittance processing.

Daily tasks include testing pharmacy networks, monitoring remittances, and recovering funds from negative balances, while ensuring adherence to contracts. The role emphasizes independent assessment to confirm Navitus is meeting contractual reimbursement obligations and