Pharmacy Auditor I-Remote - Continuous Learning Opportunities

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.

We are 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.

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!

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.
• Participate in team meetings, department meetings and committees regarding goals, vision, and strategic plans to support the compliance program objectives.
• Build and maintain relationships with internal business units and pharmacy service providers.
• 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.

What our team expects from you?

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

What can you expect from Navitus?

• Hours/Location: Monday-Friday 8:00am-5:00pm, CST-Remote
• Paid Volunteer Hours
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!
• Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

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