Sr. Administrator, Pharmacy Reimbursement

Navitus M-F 8am to 5pm ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin. Carrie Bohnart

Due to growth, we are adding a Sr. Administrator, Pharmacy Reimbursement to our team.

The Sr. Administrator, Pharmacy Reimbursement is responsible for executing and validating pharmacy reimbursement processes across adjudication, financial systems, and downstream data environments to ensure accuracy, compliance, and operational integrity. This role serves as a key technical and operational resource supporting the translation of pharmacy contractual terms into system configuration and the validation of reimbursement outputs across integrated platforms, including adjudication systems and enterprise financial systems (e.g., Oracle Fusion).

Is this you? Find out more below!

How do I make an impact on my team?

• Act as a Payments Team SME (subject matter expert) for internal and external clients.
• Play a primary role in developing training on new or existing procedures and provides training to team members.
• Support execution, quality and validation of pharmacy payment processes within Oracle Fusion, including invoice alignment, remittance outputs, and reconciliation inputs.
• Assist in identifying, remediating and resolving discrepancies between claims adjudication outputs and ERP financial transactions.
• Participate in user acceptance testing (UAT) and regression testing for Fusion-related enhancements impacting pharmacy reimbursement workflows.
• Perform root cause analysis of data discrepancies across adjudication, remittance (835), and financial systems.
• Partner with IT and Data teams to document data mappings, controls, business rules, and transformation logic impacting reimbursement.
• Support development and maintenance of data dictionaries and metadata for reimbursement-related datasets.
• Identify, document, and escalate variances in payment accuracy, timing, and completeness.
• Maintain audit-ready documentation supporting payment accuracy, recoveries, and reconciliation processes.
• Support implementation of workflow improvements across billing, remittance, and reconciliation processes.
• Participate in cross-functional initiatives to improve cycle time, reduce errors, and enhance payment transparency.
• Develop and implement standardized procedures and controls supporting scalable reimbursement operations.
• Analyze reimbursement trends and identify anomalies requiring investigation.
• Support Finance and leadership with data insights for accruals, audits, forecasting inputs, and financial reporting.
• Lead investigation, research and resolution of complex payment discrepancies and pharmacy inquiries.
• Other duties as assigned.

What our team expects from you?

• Associate’s degree in Healthcare Administration, Business, Finance, Information Systems, or a related field, or equivalent work experience, required. Bachelor’s degree preferred.
• Certification/Licenses: CPhT certification preferred.
• 3+ years of experience in PBM, managed care, healthcare operations, or a related field with exposure to claims processing, reimbursement, or payment-related functions required.
• Previous testing experience is required.
• Coursework or experience in financial systems (e.g., ERP platforms such as Oracle Fusion), data analytics, or healthcare information systems 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?

• 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-Remote

USD $74,997.43 - USD $92,021.38 /Yr.

Associate's degree in healthcare administration, business, finance, or information systems (or equivalent experience) required; bachelor's preferred; CPhT preferred; 3+ years PBM/managed care/healthcare operations experience with claims processing or reimbursement required; previous testing experience required.

Key Responsibilities

• executing reimbursement processes
• validating payment outputs
• resolving discrepancies

Skills & Tools

Oracle Fusion, ERP

Job Details

• Category: Healthcare Services - Pharmacy
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — United States or Alabama or Arizona or Arkansas or California or Colorado or Connecticut or Delaware or Florida or Georgia or Idaho or Illinois or Indiana or Iowa or Kansas or Kentucky or Louisiana or Maryland or Massachusetts or Michigan or Minnesota or Missouri or Montana or Nebraska or Nevada or New Jersey or New York or North Carolina or Ohio or Oklahoma or Oregon or Pennsylvania or Tennessee or Texas or Utah or Vermont or Virginia or Washington or Washington DC or Wisconsin
• Salary: USD 74,997 – 92,021 / year
• Languages: English

Benefits

• 401k matching
• Generous paid time off
• Tuition reimbursement
• Retirement plan
• Generous parental leave

About Navitus Health Solutions, LLC

A pharmacy benefit management company providing reimbursement and payment validation services. — Industry: Healthcare

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