Administrator, Pharmacy Reimbursement

Navitus

About 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.

Pay Range

USD $47,309.00 - USD $56,321.00 /Yr.

Work Schedule Description (e.g. M-F 8am To 5pm)

M-F 8:30am-5:00pm, CST

Overview

Due to growth, we are adding a Pharmacy Reimbursement Administrator to our Provider Services department .

The Pharmacy Reimbursement Administrator (PRA) is responsible for oversight of the translation of pharmacy contractual terms for application in Navitus systems for the purposes of adjudication, reporting, and use in downstream systems that require pharmacy reimbursement information. The PRA is also responsible for the development and execution of tests of pharmacy network rates in Navitus systems to confirm accuracy of interpretation and applied systems logic. The 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.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Interprets pharmacy contractual language to translate price elements into Navitus systems.
• In collaboration with team members, make decisions regarding the resolution of pharmacy issues.
• 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.
• Accurately enter information to maintain integrity of the claims adjudication system
• Develop processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx.
• O ther 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 com pliance 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!
  
  

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.