Auditing Project Lead jobs in Madison, WI

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.  

Due to growth, we are adding this Manager, Auditing and Testing to our Provider Services department.

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.

The Manager, Auditing and Testing will oversee and manage a team of analysts. This position is responsible for the oversight of pharmacy contract claims accuracy and audits of the pharmacy system. This position will support the Navitus Provider Services, Account Management, Government Programs, Legal and CAO departments to facilitate the successful monitoring and evaluation of our pharmacy networks and implementation of necessary system updates. This individual will be expected to understand, interpret, analyze, and integrate data, including claims utilization of current clients, the Navitus claims adjudication system, pharmacy network databases, NCPDP pharmacy files, and other databases from time-to-time. 

Is this you? Find out more below! 

How do I make an impact on my team?  

• Responsible for the career development and training of Pharmacy Audit and Testing Team.
• Collaborates with operational departments, identifies and implements appropriate changes in operating procedures and systems that might be required to accommodate PBM contracts. 
• Acquires and maintains a thorough understanding of all implications of adjudication platform changes while coordinating accordingly with all upstream and downstream stakeholders.
• Initiates and assists coordination within internal teams, such as, Client Services and BCA, in order to improve efficiency, accuracy, and capacity of the adjudication platform functionality.
• Participates in and supports all external delegation and financial audits of the pharmacy network pharmacies.
• Responsible for all quality reviews of the data within pharmacy network database. This includes the claims processing system and any other tool that utilizes data related to the pharmacies.
• Generate reports on network performance to share with Senior Leadership.
• Ensure compliance with legal and compliance requirements for network pricing
• Develop or enhance systems to house Navitus network pharmacy databases.
• Oversees and addresses all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general.

What our team expects from you? 

• BA/BS Required. Educational concentration consisting of business, informational systems, or mathematics preferred. Additional courses in a health-related field, especially pharmacy, desirable
• Two to three years experience in PBM analytics or related business environment. Knowledge of health care processes or pharmaceutical claim reimbursement methodologies 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-5:30pm 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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