Pharmacy Reimbursement Administrator

Navitus Health Solutions

. Administer technical processes supporting system price setups, electronic funds transfer, and remittance setups according to policy .

Posted 9/22/2026full-timeRemote • United StatesMid-LevelSenior💰 $48,729 - $58,010 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in administering technical processes for system price setups and electronic funds transfer while ensuring compliance with financial regulations. Proficient in data management and quality assurance within pharmacy network pricing and contract compliance.

Highest-signal resume keywords

Pharmacy Network Pricing SetupData Import and ExportQuality AssuranceCompliance MonitoringFinancial Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Process Control ImplementationRate Testing and AnalysisClaims AdjudicationData Dictionary ManagementService Request Submission

Soft Skills

Cooperative InteractionRespectful Communication

Tools & Technologies

Navitus SystemsPharmacy Credential and Contracting DatabaseNCRx

Certifications & Qualifications

CPhT

Industry Keywords

PBMManaged CareFinancial RegulationsCompliance ProgramOverpayment Monitoring

About the role

Key responsibilities & impact

Administer technical processes supporting system price setups, electronic funds transfer, and remittance setups according to policy
Ensure appropriate controls and oversight reporting across the end-to-end process
Identify, define, and implement new process controls as needed
Resolve pharmacy network pricing setup issues and research pricing inquiries
Develop processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx
Perform pharmacy network rate testing, analysis, and impact assessment
Perform ongoing quality assurance of pharmacy network rates to mitigate incorrect claims adjudication
Identify and escalate improper payments and 835 issues
Maintain department detail work instructions and policies
Monitor and report non-compliance relating to overpayments, transaction standard issues, and financial regulations
Provide offset detail to pharmacies impacted in a recovery project before receipt of payment and remit
Oversee applicable financial and metrics reporting, data dictionaries, inquiries, and audits
Submit service requests for necessary network updates, audit networks for price change accuracy, monitor compliance with pharmacy provider contracts, set up electronic payments and remits, and respond to payment issue questions
Make independent assessments to confirm compliance with contractual reimbursement obligations
Perform other duties as assigned

Requirements

What you’ll need

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

Benefits

Comp & perks

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%