WI3661991

1

Bachelor's Degree

Bachelors Degree

$51123 + yearly

Unspecified

40

JOB REQUIREMENTS: 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. Due to
growth, we are adding this Analyst, Pharmacy Audit to our Provider
Services department. 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. The Analyst, Pharmacy Audit is responsible for the oversight of
Navitus\' contractual pharmacy network reimbursement accuracy. The
individual in this position is expected to make independent assessments
to confirm Navitus is conforming to contractual reimbursement
obligations contained in Retail, Specialty, and Mail Order pharmacy
agreements. The Analyst will continually review and monitor claims data,
create, and update procedures, audit networks for price change accuracy,
monitor compliance with Navitus pharmacy provider contracts, communicate
findings, and work with applicable teams to remediate errors. Is this
you? Find out more below! How do I make an impact on my team? 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. Continuously review and pro-actively
identify areas of opportunity for reimbursement compliance for both
providers and clients, including analysis and communication of
activities. 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. Periodic and
detailed reporting of contractual compliance activities and
opportunities to Provider Services team and\... For full info follow
application link. Navitus Health Solutions is an Equal Opportunity
Employer: Disabled/Veterans/Male/Female/Minority/Other \*\*\*\*\*
APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/EBE976B961944E53