United States onlyCompany
NavitusAbout 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.Pay Range
USD $72,813.00 - USD $89,341.00 /Yr.Work Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am-5pm, CTRemote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Overview
Due to growth we are adding a Provider Services Manager to our team!
The Manager, Provider Services is responsible for the oversight for executing contracts, credentials or payment setups with pharmacies, responding to pharmacy inquiries and completing the tactical and operational tasks required to maintain contracted pharmacy networks. The individual will ensure information contained in Navitus’ contract management systems are accurate and up to date. The individual(s) in this position will oversee end to end operational aspects of administration, analysis, and quality assurance for credentials and network design and management through management of the Provider Relations Coordinators or Credentialing Coordinators or Pharmacy Reimbursement Administrators. The individual is responsible for ensuring data integrity of the credentials, contract or payment documents that are entered into the pharmacy network database as well as the claims processing system adjudicating pharmacy claims according to Navitus agreements and Navitus business rules. The individual will maintain and monitor the team’s performance as it relates to operational duties of the department and will report all performance metrics to leadership.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
- Point of contact with external pharmacy partners and strategic vendors
- Supervises functional area staff and oversees day-to-day functional area operational activities and work product including but not limited to maintenance of functional area databases; reporting requests; contract, network and credentialing updates; payment inquiries; communications and outreach; service desk requests
- Audits internal files or systems to identify non-compliance and oversees resolution of issues found
- Oversees quality reviews of the databases (e.g. contracting, credentialing, NCRx) and functional area reports to ensure data integrity and completeness
- Initiates and assists coordination within internal teams, such as, Client Services, Finance, Compliance, BCA and IT, in order to improve efficiency, accuracy, and capacity of the adjudication platform functionality
- Monitors and extracts data from federal and/or state databases to support functional area work
- Represents functional area for external regulatory audits and financial audits
- Supports compliance with URAC, Government entities and Navitus’ policy and procedures to ensure applicable quality, regulatory and organizational standards are met
- Identifies and researches issues impacting functional area work, collaborates with internal and external customers to resolve, and oversees any corrective action required
- Other duties as assigned
Qualifications
What our team expects from you?
- College Degree or equivalent experience is preferred
- Advanced technical education and pharmacy technician certification is required
- 3-6 years business-setting or healthcare experience
- Retail pharmacy experience or experience in a managed care pharmacy setting desired
- Prior experience analyzing medical and/or pharmacy claims or credentials are highly desired
- 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?
• 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
