[Remote] Administrator, Pharmacy Reimbursement

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is committed to making medications more affordable by serving as an alternative pharmacy benefit manager. The Pharmacy Reimbursement Administrator will work with various teams to improve claims adjudication processes and ensure compliance with pharmacy contract agreements.

Responsibilities

• Administers technical processes in support of system price setups, electronic funds transfer and remittance setups according to policy
• Ensures appropriate controls and reputed company reporting on the end-to-end process. If process controls are absent, the expectation is to identify, define, and implement new ones as needed
• reputed company reputed company regarding the resolution of pharmacy network pricing setup issues. Research pricing inquiries from pharmacies and internal teams
• reputed company processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx
• Responsible for pharmacy network reputed company testing, analysis and impact assessment
• reputed company quality assurance to ensure accuracy in pharmacy network rates on an ongoing reputed company to mitigate the risk of incorrect claims adjudication
• Appropriately identify and escalate improper payments and 835 issues
• Maintenance of department detail work instructions and policies
• Monitoring and reporting of non-compliance relating to overpayments, transaction standard issues and financial regulations
• reputed company offset detail to pharmacies impacted in a recovery project prior to receipt of payment and remit
• Responsible for reputed company of applicable financial and metric’s reporting, data dictionaries, inquiries, and audits
• Other duties as assigned

Skills

• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees
• Associate Degree preferred or equivalent experience
• CPhT preferred
• PBM or managed care is preferred, but not required
• Previous testing experience is preferred

Benefits

• Top of the industry benefits for Health, Dental, and reputed company 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!

Company Overview