Remote Pharmacy Reimbursement Specialist

Navitus; Richmond (VA); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible spending account

Education assistance

Professional membership assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. You will collaborate with providers, IT, and operations to improve claims adjudication, test pharmacy networks, and oversee EFT and 835 remittances and recoveries from pharmacies.

You will analyze network pricing, maintain process documentation, ensure compliance with contracts, and generate reports on reimbursement and remittance activities. A strong attention to detail is essential.

Qualifications

• Associate Degree preferred or equivalent experience.
• CPhT certification preferred.
• PBM or managed care experience preferred.
• Previous testing experience preferred.
• Ability to interact cooperatively and respectfully with colleagues.

Responsibilities

• Administers cost, EFT and remittance processes.
• Maintains end-to-end controls reporting for reimbursement processes.
• Resolves pricing setup issues for pharmacy networks.
• Develops data import/export processes for Navitus systems.
• Tests pharmacy network rates and assesses impact on claims.
• Ensures accuracy of network rates to mitigate incorrect adjudication.
• Identifies and addresses improper payments and 835 issues.
• Maintains department work instructions and policies.
• Monitors non-compliance relating to overpayments and financial regulations.
• Provides offset details to pharmacies in recovery projects.

Education

Associate Degree preferred or equivalent experience

CPhT preferred

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. You will collaborate with providers, IT, and operations to improve claims adjudication, test pharmacy networks, and oversee EFT and 835 remittances and recoveries from pharmacies.

You will analyze network pricing, maintain process documentation, ensure compliance with contracts, and generate reports on reimbursement and remittance activities. A strong attention to detail is essential.