[Hiring] Reimbursement Analyst, Pharmacy Network @Navitus Health Solutions, LLC

Role Description

Navitus Health Solutions is seeking a Reimbursement Analyst, Pharmacy Network to join our team! The Analyst supports and evaluates agreements with providers and the Maximum Allowable Cost (MAC) program through financial price modeling, analysis, and reporting. This position will communicate and work cross-functionally with other teams on generic trends and generic drug discount change effects. Provider and network performance will be analyzed in support of network development, contracting negotiations, and RFP proposals. The Analyst, under the direction and supervision of the Provider Services leadership, is responsible for maintaining a competitive and market-leading MAC program. The Analyst will also be responsible for managing and responding to pharmacy pricing inquiries in compliance with Navitus response protocol. This position will help monitor and evaluate state MAC requirements to ensure Navitus remains compliant with MAC management and inquiry. The Analyst will assist in working with internal and external partners including pharmacies, clients, vendors, and internal department liaisons to implement and maintain an effective MAC program.

Responsibilities

• Operation and timely administration of the Navitus generic pricing programs including MAC, NADAC, or other pricing structures.
• Determine products to be included on the MAC list and the associated price per unit, updating all pricing within Navitus systems.
• Field, analyze, and resolve inquiries from pharmacy providers, clients, and internal teams.
• Evaluate state MAC requirements to ensure Navitus MAC management remains compliant.
• Monitor industry events to determine availability of generic introduction to the marketplace and manage exclusivity timeline for newly introduced generics.
• Manage consolidation of generic manufacturers in the market that will affect MAC pricing.
• Continuously review and pro-actively identify areas of opportunities for pricing and discount performance improvement.
• Research customer and contract issues that may affect account planning, strategies, and proposals; assist with RFP responses as necessary.
• Periodic and detailed reporting of activities and opportunities to Provider Services team and cross-functional leadership.
• Research external and internal pricing trends and opportunities to contribute to overall pricing strategy.
• Perform analyses as requested by internal and external business owners, or in support of identified business objectives, with special focus on pharmacy network profitability and/or client discounts.
• Other duties as assigned.

Qualifications

• Bachelor’s degree required. Emphasis in business, finance, economics, or actuarial science strongly preferred. Recent college graduates are encouraged to apply.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• 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!