Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is a pharmacy benefit management company seeking an Analyst, Pharmacy Contract Audit. The role oversees pharmacy network reimbursement accuracy by reviewing claims data, interpreting contract terms, auditing pricing, monitoring compliance, reporting findings, and coordinating remediation of errors across teams.
Responsibilities
- Analytical and operational understanding of Navitus’ reimbursement programs including AWP, WAC, MAC, NADAC, FUL, AAC, Average Dispensing Fee, and other pricing structures
- Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, auditors, and internal teams regarding Retail, Specialty, and Mail Order pricing errors with focus on the root cause
- Interpret pharmacy contract language to compare Retail, Specialty, and Mail Order contract pricing to adjudicated claims activity
- Develop and maintain appropriate controls and oversight reporting on the end-to-end process of Retail, Specialty, and Mail Order contract pricing. If process controls are absent, the expectation is to identify, define, and implement new processes as needed
- Responsible for pharmacy network rate testing, chain audits, analysis, and impact assessment
- Make decisions regarding the resolution of pharmacy network pricing setup issues
- Submit service requests, recovery requests, and/or engage applicable teams to make system updates/changes
- Understand, follow, and improve current operational and administrative processes
- Periodic and detailed reporting of contractual compliance activities and opportunities to Provider Services team and cross-functional leadership
- Other duties as assigned
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Skills
- Bachelor's degree or equivalent experience required
- Minimum two years analytics experience required
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
- Emphasis in business, finance, economics, or operations preferred
Benefits
- 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!
Company Overview