Job description
Company
NavitusAbout Us
Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.. Current associates must use SSO login option at to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.Pay Range
USD $48,728.61 - USD $58,010.26 /Yr.STAR Bonus % (At Risk Maximum)
7.50 - Salaried Non-Management except pharmacistsWork Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pmRemote Work Notification
ATTENTION: Lighthouse is unable to offer remote work to residents of Alaska, Delaware, Hawaii, Idaho, Iowa, Louisiana, Maine, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Rode Island, South Carolina, South Dakota, Vermont, West Virginia, and Wyoming.Overview
Navitus Health Solutions is seeking a Pharmacy Reimbursement Administrator to join our team!
The Pharmacy Reimbursement Administrator (PRA) works in partnership with the Provider Relations Coordinators, IT Client Operations, and others to continually review, monitor, and update procedures to improve efficiencies of claims adjudication administration. The PRA will test and review pharmacy networks to ensure that claims are adjudicating per Navitus’ pharmacy contract agreements. The PRA is responsible for the process of pharmacy remittances, including the accuracy of data in pharmacy electronic payments (EFT) and/or 835-remittance advice and the oversight of recoveries of funds from pharmacies. The PRA is responsible for recuperation of monies from pharmacy providers in negative balance status, as well as developing and providing reports to Navitus associates of all reimbursement, recovery, and remittance activities. Day-to-day activities include submitting service requests for any necessary network updates, auditing networks for price change accuracy, monitoring compliance with Navitus pharmacy provider contracts, setting up electronic payments and remits, and responding to questions related to payment issues. The individual in this position is expected to make independent assessments to confirm Navitus is conforming to contractual reimbursement obligations contained in pharmacy agreements.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
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. If process controls are absent, the expectation is to identify, define, and implement new ones as needed
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, including the Pharmacy Credential and Contracting database and NCRx
Responsible for pharmacy network rate testing, analysis and impact assessment
Perform quality assurance to ensure accuracy in pharmacy network rates on an ongoing basis to mitigate the risk of incorrect claims adjudication
Appropriately identify and escalate 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
Responsible for oversight of applicable financial and metric’s reporting, data dictionaries, inquiries, and audits
Other duties as assigned
Qualifications
What our team expects from you?
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
What can you expect from Navitus?
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750!
Location : Address
RemoteLocation : Country
USOriginally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.