Remote Pharmacy Reimbursement Specialist

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

Benefits offered by this job

Health benefits

Dental & Vision

PTO 20 days

Parental leave 4 weeks

Holidays 9 days

401K match 5%

Adoption assistance

FSAs

Education & membership support

Referral bonus $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA works in partnership with the Provider Relations Coordinators, IT Client Operations, and others to review, monitor, and update procedures to improve efficiencies of claims adjudication administration.

The PRA is responsible for pharmacy remittances, EFT data, 835-remittance advice, and recoveries of funds from pharmacies.

Qualifications

• Associate Degree preferred or equivalent experience.
• CPhT preferred.
• 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 consistently interact cooperatively and respectfully with other employees.

Responsibilities

• Administers technical processes in support of system price setups, electronic funds transfer and remittance setups according to policy.
• Ensures appropriate controls and oversight reporting on the end-to-end process.
• Make decisions regarding the resolution of pharmacy network pricing setup issues.
• Research pricing inquiries from pharmacies and internal teams.
• Develop processes to import and export data from Navitus systems.
• Responsible for pharmacy network rate testing, analysis and impact assessment.
• Perform quality assurance to ensure accuracy in pharmacy networkrates on an ongoing basis.
• Identify and elevate improper payments and 835 issues.
• Maintenance of department detail work instructions and policies.
• Monitoring and reporting of non-compliance relating to overpayments, transaction standard issues and financial regulations.
• Provide offset detail to pharmacies impacted in a recovery project prior to receipt of payment and remit.
• Oversee applicable financial and metric reporting, data dictionaries, inquiries, and audits.

Skills

Associate Degree

CPhT

PBM experience

Testing experience

Teamwork

Education

Associate Degree or equivalent

CPhT credential

Job description

Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team. The PRA works in partnership with the Provider Relations Coordinators, IT Client Operations, and others to review, monitor, and update procedures to improve efficiencies of claims adjudication administration.

The PRA is responsible for pharmacy remittances, EFT data, 835-remittance advice, and recoveries of funds from pharmacies.