Remote Pharmacy Reimbursement Specialist

Navitus; Springfield (IL); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave (4 weeks)

9 paid holidays

401K match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program

Job summary

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to join our team. The PRA partners with Provider Relations, IT, and others to review and improve claims adjudication processes, testing networks to ensure per-contract compliance, and overseeing EFT/remittance data and recoveries.

You will handle network rate testing, data imports/exports, and reporting on reimbursement and remittance activities while maintaining controls and policy adherence.

Qualifications

• Associate degree preferred or equivalent experience. CPhT preferred.
• PBM or managed care experience preferred but not required.
• Previous testing experience preferred.
• Participate in, adhere to, and support compliance program objectives.
• Ability to interact cooperatively with others.

Responsibilities

• Administers technical processes supporting price setups, EFT and remittance setups.
• Ensures controls and reporting for end-to-end process; identify and implement new controls as needed.
• Resolve pharmacy network pricing setup issues; research pricing inquiries from pharmacies and internal teams.
• Develop processes to import/export data from Navitus systems (e.g., NCRx).
• Responsible for pharmacy network rate testing, analysis and impact assessment.
• Perform QA to ensure accuracy in pharmacy network rates to prevent incorrect claims adjudication.
• Identify and escalate improper payments and 835 issues.
• Maintain department work instructions and policies.
• Monitor non-compliance relating to overpayments and regulatory standards.
• Provide offset details to pharmacies in recovery projects; oversee remittance.

Skills

PBM experience

Compliance

Testing experience

Education

Associate degree

CPhT (Preferred)

Tools

NCRx

Job description

Navitus Health Solutions seeks a Pharmacy Reimbursement Administrator to join our team. The PRA partners with Provider Relations, IT, and others to review and improve claims adjudication processes, testing networks to ensure per-contract compliance, and overseeing EFT/remittance data and recoveries.

You will handle network rate testing, data imports/exports, and reporting on reimbursement and remittance activities while maintaining controls and policy adherence.