Remote Pharmacy Reimbursement Specialist

Navitus Health Solutions; United States; Remote; USD 49,000 - 58,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

401K match

Adoption assistance

Flexible Spending Account

Education assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team remotely in the United States. The role collaborates with Provider Relations, IT Client Operations, and others to improve claims adjudication efficiency and ensure remittances and EFT data accuracy.

Responsibilities include network testing, recovery of funds from negative balances, and developing reports on reimbursement activities. A strong focus on compliance and process improvement is required.

Qualifications

• Associate Degree preferred or equivalent experience.
• CPhT preferred.
• PBM or managed care experience preferred.

Responsibilities

• Administers reimbursement processes in line with policy.
• Ensures controls and oversight reporting for end-to-end processes.
• Researches pricing inquiries from pharmacies and internal teams.
• Coordinate data imports/exports in Navitus systems.
• Oversee pharmacy network rate testing and remittance accuracy.
• Identify improper payments and 835 issues.
• Maintain department work instructions and policies.
• Report non-compliance and overpayments.

Skills

PBM experience

Regulatory compliance

Data analysis

Education

Associate Degree preferred or equivalent experience

CPhT preferred

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team remotely in the United States. The role collaborates with Provider Relations, IT Client Operations, and others to improve claims adjudication efficiency and ensure remittances and EFT data accuracy.

Responsibilities include network testing, recovery of funds from negative balances, and developing reports on reimbursement activities. A strong focus on compliance and process improvement is required.