Pharmacy Auditor I- Hybrid

Company

Navitus

About Us

Navitus - 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._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

Pay Range

USD $45,931.00 - USD $54,680.00 /Yr.

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F: 8:00 am - 5:00 pm CST

Remote Work Notification

ATTENTION: 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.

Overview

 

This is a Hybrid position in Madison or Appleton WI 

 

In a post-adjudication work environment, the Pharmacy Desk Auditor I will review pharmacy claims submission data to identify payment errors, provide outreach and education to pharmacies, ensure legal compliance and Navitus PBM adherence to contract agreement rules. This position works collaboratively with the Pharmacy Audit team to meet all contract and internal timelines/deadlines. This role requires knowledge of pharmacy billing and operational practices. The Pharmacy Desk Auditor I position requires a thorough knowledge of prescription medications including their use, packaging, dispensing, and billing processes. Attention to detail, awareness of key regulatory requirements, excellent communication skills and customer-centric skills for both internal and external customers is also required. This position can be office based or remote and may include limited travel.

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

• Audit pharmacy claims in a pre-pay or post-pay status, identifying aberrancies for outreach to pharmacies for education and correction
• Analyze data sets to trend over time identifying outliers of that data set when compared to other pharmacies or standards
• Ensure auditing processes meet all regulatory and client contractual requirements
• Identify trends and events that impact pharmacy and administrative costs
• Participate in process re-design, system enhancements and automation opportunities for cost reduction
• Recognize opportunities for improvement and efficiencies in current processes
• Work closely with internal departments on the monitoring of pharmacy billing patterns and behavior
• Summarize, report, and communicate key discoveries and audit results to the team and other departments as needed. This may include written reports
• Evaluate audit results for potential referral to our internal Special Investigations Unit (SIU) which may include fraud, waste, and abuse
• Other duties as assigned

Qualifications

What our team expects from you?

• Pharmacy Technician Certification (CPhT) required
• Current licensure as a technician in the state of residence required (if applicable)

• This is a Hybrid position in Madison or Appleton WI 

• College degree preferred or equivalent experience required
• Minimum 5 years of experience as a certified pharmacy technician in a retail, LTC or home infusion pharmacy setting required or equivalent
• 1-3 years knowledge of pharmaceutical claims adjudication systems or health insurance strongly preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

#LI-Hybrid

Location : Address

1025 West Navitus Dr. 

Location : City

Appleton

Location : State/Province

WI

Location : Postal Code

54913

Location : Country

US