Pharmacy Reimbursement Administrator

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee technical processes related to system price configurations, electronic funds transfers, and remittance setups in accordance with established policies.

• Ensure adequate controls and oversight reporting throughout the entire process.

• Identify, define, and implement new process controls as necessary.

• Address pharmacy network pricing setup challenges and investigate pricing inquiries.

• Create procedures for importing and exporting data from Navitus systems, which include the Pharmacy Credential and Contracting database and NCRx.

• Conduct testing, analysis, and impact assessments on pharmacy network rates.

• Perform continuous quality assurance checks on pharmacy network rates to prevent incorrect claims adjudication.

• Recognize and escalate issues related to improper payments and 835 discrepancies.

• Maintain detailed work instructions and policies for the department.

• Monitor and report non-compliance concerning overpayments, transaction standard issues, and financial regulations.

• Provide detailed information to pharmacies affected by a recovery project prior to payment receipt and remittance.

• Supervise relevant financial and metrics reporting, data dictionaries, inquiries, and audits.

• Submit service requests for essential network updates, audit networks for accuracy in price changes, monitor adherence to pharmacy provider contracts, facilitate electronic payments and remittances, and address payment-related inquiries.

• Make independent evaluations to ensure compliance with contractual reimbursement commitments.

• Perform additional duties as assigned.

⛳️ Requirements

• Associate Degree preferred or equivalent experience.

• CPhT certification preferred.

• Experience in PBM or managed care is preferred, but not mandatory.

• Previous testing experience is preferred.

• Actively participate in, comply with, and support compliance program objectives.

• Ability to consistently engage cooperatively and respectfully with colleagues.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance benefits.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program offering up to $750.