- 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 cross-functional leadership.
- Identify, advocate, and implement continual process improvement of policies and procedures to maximize quality and efficiencies.
- Bachelor's degree or equivalent experience required. Emphasis in business, finance, economics, or operations preferred
- 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
- Hours/Location: Monday-Friday 8:00am-5:30pm CST, Remote or Hybrid in our Madison WI, Appleton WI or Austin TX Office
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
-
Remote Pharmacy Technician
1 day ago
Tarrytown Expocare LLC Austin, United StatesJob Description · Job DescriptionDescription:As an Order Entry Technician, you will be responsible for initiating and processing new or renewed orders, managing order exceptions or clarifications, and adjudicating insurance claims. · Requirements:Duties & Responsibilities · Accur ...
-
Clinical Systems Analyst
1 week ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · *** This position can telework % from anywhere in Texas consistent with HHS telework policies. *** · The Systems Analyst reports to Application Manager within Health and Specialty Care Systems (HSCS) unit of Information Technology (IT) department for Health and ...
-
Clinical Account Consultant
2 weeks ago
HCSC Austin, United States Full timeAt HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. · Come join us and be part of a purpos ...
-
TEXAS DEPARTMENT OF MOTOR VEHICLES Austin, United StatesGENERAL DESCRIPTION · Our mission at the Texas Department of Motor Vehicles (TxDMV) is to serve, protect and advance the citizens and industries in the state with quality motor vehicle related services. We are a dynamic state agency dedicated to customer service, consumer protect ...
-
TxDMV - Internal Auditor I-II (Hybrid)
2 weeks ago
TEXAS DEPARTMENT OF MOTOR VEHICLES Austin, United StatesGENERAL DESCRIPTION · Our mission at the Texas Department of Motor Vehicles (TxDMV) is to serve, protect and advance the citizens and industries in the state with quality motor vehicle related services. We are a dynamic state agency dedicated to customer service, consumer protect ...
-
ERS-Senior Internal Auditor
2 weeks ago
EMPLOYEES RETIREMENT SYSTEM Austin, United StatesERS-Senior Internal Auditor Organization · :EMPLOYEES RETIREMENT SYSTEM Primary Location · :Texas-Austin Work Locations · :Main Office E 18th StreetAustin78701 Job · :Business and Financial Operations Employee Status · :Regular Schedule · :Full-timeStandard Hour ...
-
Inside Sales Representative
3 weeks ago
SCA Pharmaceuticals, LLC Austin, United States:SCA Pharmaceuticals is a dynamic rapidly growing company consisting of passionate individuals who believe in our mission of providing high quality medications that are critical in saving and sustaining human life. SCA Pharma is an FDA 503B outsourcing facility providing customiz ...
-
Kodiak Coding Audit Consultant
3 weeks ago
Crowe Austin, United States Full timeDescription · : The Coding Audit Consultant conducts independent and integrated internal audits and consulting engagements utilizing their coding knowledge, audit documentation skills and Kodiak's proprietary audit documentation software. This role will also assist other Kodiak ...
-
Manager of SEC Reporting
3 weeks ago
The HT Group Austin, United StatesLocation: Austin · Remote: Remote · Type: Direct Hire · Job #18759 · Salary: $130,000 - $140,000 USD · The HT Group has partnered with a premier, international semiconductor manufacturing client in the search for a qualified SEC Reporting Manager for an immediate, growth-cre ...
-
Premium Audit Reviewer
1 week ago
Texas Mutual Austin, United States Full timeWere excited youre considering joining a great place to work · Texas Mutual is deeply committed to creating and maintaining an environment of mutual respect and is proud to be an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consi ...
-
Medical Director Remote Texas
3 weeks ago
UnitedHealth Group Austin, United StatesOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel ...
-
Assistant Corporate Controller--remote
1 week ago
Mason & Blair, LLC Austin, United StatesHARD REQUREMENTS: · BIG 4 CPA WITH ACCOUNTING LEADERSHIP EXPERIENCE IN PUBLICLY-TRADED COMPANY · PACIFIC TIME ZONE ONLY · Remote role with SF bay area based publicly-traded SaaS company. Seeking experienced Assistant Controller or Accounting Director ready to step into Controlle ...
-
TxDMV - Cybersecurity Analyst I - II (Remote)
2 weeks ago
TEXAS DEPARTMENT OF MOTOR VEHICLES Austin, United StatesGENERAL DESCRIPTION · Our mission at the Texas Department of Motor Vehicles (TxDMV) is to serve, protect and advance the citizens and industries in the state with quality motor vehicle related services. We are a dynamic state agency dedicated to customer service, consumer protect ...
-
Compliance Investigator
1 week ago
ICU Medical Austin, United States Full timePosition Summary · The Sr. Program Manager has overall accountability for multiple programs and projects from contract through Go-Live. The Sr. Program Manager is responsible to ensure cost, schedule, and scope of their program(s) stay aligned with the established and approved ...
-
Information Security Architect
1 week ago
Western Union Austin, United States Full timeSenior Cybersecurity Architect – Denver, CO OR Austin, TX (Hybrid) · Are you an expert in cybersecurity with a passion for leading high stakes architectural projects in a large global company? Do you thrive in diverse, globally connected environments where your contributions sha ...
-
OCA - TIDC Auditor IV (Fiscal Analyst)
2 weeks ago
OFFICE OF COURT ADMINISTRATION Austin, United StatesOCA - TIDC Auditor IV (Fiscal Analyst Organization · :OFFICE OF COURT ADMINISTRATION Primary Location · :Texas-Austin Job · :Business and Financial Operations Employee Status · :Regular Schedule · :Full-timeStandard Hours Per Week:40.00 Travel · :Yes, 25 % of th ...
-
DPS - CAO - CAO Assistant Manager - 1204
2 weeks ago
TEXAS DEPARTMENT OF PUBLIC SAFETY Austin, United StatesGENERAL DESCRIPTION · : Perform highly advanced and/or supervisory (senior-level) professional analysis and auditing work. Work involves overseeing and conducting organizational evaluations, evaluating systems and procedures, evaluating operations and policies and procedures to a ...
-
State of Texas Austin, United StatesGENERAL DESCRIPTION: · SPECIFIC JOB RESPONSIBILITIES: Reviews Audit Reports submitted annually for the Public Facility CorporationsPrepares written reports within 45 days of receipt of the Audit Report, summarizing results that may address findings of noncompliance, recommendati ...
-
Chief Financial Officer
3 weeks ago
Family Eldercare Austin, United StatesFamily Eldercare is seeking its next Chief Financial Officer Are you a controller or Director of Finance with extensive experience in day-to-day financial operations, ready yo drive long-term strategic goals? Join us by applying through the link · Position Summary · The Chief Fi ...
-
Psychiatrist III
1 week ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Psychiatrist III: · Would you thrive in an environment where you learn and grow personally and professionally all while helping make a positive impact on people's lives? Do you appreciate being around others like yourself who are dependable, trustworthy, hard w ...
Analyst, Pharmacy Audit-Remote - Austin, United States - Navitus
Description
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?
What our team expects from you?
What can you expect from Navitus?
#LI-Remote #LI-Hybrid
