Reimbursement Analyst, Pharmacy Network

Summary

Navitus Health Solutions is a pharmacy benefit management company focused on making medications more affordable. The Reimbursement Analyst supports pharmacy provider agreements and generic pricing programs through financial modeling, compliance evaluation, reporting, inquiry resolution, and analysis of network performance and reimbursement strategies.

Responsibilities

• Operation and timely administration of the Navitus generic pricing programs including MAC, NADAC, or other pricing structures, which includes determining products to be included on the MAC list and the associated price per unit and updating all pricing within Navitus systems
• Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, and internal teams
• Evaluate state MAC requirements to ensure Navitus MAC management remains compliant
• Monitor industry events to determine availability of generic introduction to the marketplace and manage exclusivity timeline for newly introduced generics
• Manage consolidation of generic manufacturers in the market that will affect MAC pricing
• Continuously review and pro-actively identify areas of opportunities for pricing and discount performance improvement, including analysis and communication of reimbursement activities
• Research customer and contract issues that may affect account planning, strategies, and proposals. Assists with RFP responses as necessary
• Periodic and detailed reporting of activities and opportunities to Provider Services team and cross-functional leadership
• Research external and internal pricing trends and opportunities to contribute to overall pricing strategy
• Perform analyses as requested by internal and external business owners, or in support of identified business objectives, with special focus on pharmacy network profitability and/or client discounts
• 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 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 actuarial science strongly preferred

Qualifications

Must Haves

• Bachelor's degree required
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Nice to Haves

• Emphasis in business, finance, economics, or actuarial science strongly 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!
• Remote work; Navitus is 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.