Navitus Health Solutions
Analyst, Technical Operations Government Programs
Navitus Health Solutions, Appleton, Wisconsin, United States, 54914
Company
Navitus
About 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.
Job Details
Category: Information Technology
Position Type: Full-Time
Remote: Yes
Job ID: 2025-5409
Location 1025 West Navitus Dr. Appleton, WI 54913, US
Pay Range USD $42,505.00 - USD $50,601.00 /Yr.
STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists
Work Schedule Description M-F 7:30am to 4pm
Remote Work Notification ATTENTION: Navitus is 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.
Overview Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team! The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Is this you? Find out more below!
Responsibilities Assignments may include one or more of the following: Employer Group Waiver Plan (EGWP) enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing
Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk
Ensure process documentation accurately reflects the current process and update when necessary
Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications
Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance
Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution
As needed, may require working outside of normal business hours to complete time sensitive processes
Other duties as assigned
Qualifications
Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent
1+ years' work experience
Experience in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization is preferred
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!
#LI-Hybrid
#J-18808-Ljbffr
About 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.
Job Details
Category: Information Technology
Position Type: Full-Time
Remote: Yes
Job ID: 2025-5409
Location 1025 West Navitus Dr. Appleton, WI 54913, US
Pay Range USD $42,505.00 - USD $50,601.00 /Yr.
STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists
Work Schedule Description M-F 7:30am to 4pm
Remote Work Notification ATTENTION: Navitus is 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.
Overview Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team! The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Is this you? Find out more below!
Responsibilities Assignments may include one or more of the following: Employer Group Waiver Plan (EGWP) enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing
Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk
Ensure process documentation accurately reflects the current process and update when necessary
Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications
Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance
Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution
As needed, may require working outside of normal business hours to complete time sensitive processes
Other duties as assigned
Qualifications
Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent
1+ years' work experience
Experience in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization is preferred
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!
#LI-Hybrid
#J-18808-Ljbffr