Administrator, Pharmacy at Denver, Colorado

Pharmacy Reimbursement Administrator
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.

Responsibilities
• 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
• Dev