Remote Pharmacy Reimbursement Specialist

Navitus; Salem (OR); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

20 days paid time off

4 weeks paid parental leave

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to support claims adjudication, EFT/remittance, and recoveries. You will work with Provider Relations, IT, and others to improve reimbursement processes and ensure contract compliance.

Daily tasks include testing networks, auditing price changes, submitting service requests for network updates, and producing reports on reimbursement and remittance activities. Strong analytical and collaboration skills are essential.

Qualifications

• Associate Degree preferred or equivalent experience.
• PBM or managed care is preferred, but not required.
• Previous testing experience is preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to interact cooperatively and respectfully with other employees.

Responsibilities

• Administers processes for price setups, EFT and remittance setups according to policy.
• Ensures controls and oversight reporting on end-to-end processes.
• Resolves pharmacy network pricing setup issues and researches inquiries.
• Develops data import/export processes for Navitus systems.
• Responsible for network rate testing, analysis and impact assessment.
• Performs QA to ensure accuracy in network rates to prevent incorrect claims.
• Identifies improper payments and 835 issues and escalates as needed.
• Maintains work instructions and policies for the department.
• Monitors non-compliance related to overpayments and financial regulations.
• Provides offset details to pharmacies in recovery projects before payment receipt.
• Oversees financial and metrics reporting, data dictionaries, and audits.
• Performs other duties as assigned.

Skills

PBM knowledge

Managed care

Testing experience

Compliance knowledge

Education

Associate Degree

CPhT

Job description

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to support claims adjudication, EFT/remittance, and recoveries. You will work with Provider Relations, IT, and others to improve reimbursement processes and ensure contract compliance.

Daily tasks include testing networks, auditing price changes, submitting service requests for network updates, and producing reports on reimbursement and remittance activities. Strong analytical and collaboration skills are essential.