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“Navitus Health Solutions, LLC” Company Details
| Company Name | Navitus Health Solutions, LLC |
| Rating | 3.2 |
| Job Type | Part-time |
| Job Position | Remote Position |
Tester, PA Accel Job Overview
Experience with Prior Authorization and/or testing and a “track record” of tangible success, and team collaboration/relationship-building/management is…
What to do in Navitus Health Solutions, LLC company Job
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. Pay Range: USD $19.60 – USD $23.06 /Hr. Work Schedule Description (e.g. M-F 8am to 5pm): M-F 8am to 5pm Overview:
Due to growth, we are adding a Tester, PA Accel to our Prior Authorization department.
The Tester, PA Accel is to be a subject matter expert for testing of the automated Prior Authorization (PA) tool, PA Accel. This position ensures efforts are in alignment with the automated Prior Authorization team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering Prior Authorization criteria. The primary functions of the Tester, PA Accel involve performing and documenting Prior Authorization criteria configuration testing ensuring Navitus maintains an accurate, efficient, and versatile automated Prior Authorization system. This position develops tactical tasks and processes to incorporate client and company initiatives into testing to ensure the integrity of pharmacy claims processing, as it relates to Prior Authorization criteria. Individuals in this role must use sound business judgement and demonstrate the ability to continually prioritize tasks, as customer experience and client financials are directly influenced by their quality of work.
Is this you? Find out more below!
Responsibilities:
How do I make an impact on my team?
- Completes scheduled and urgent automated Prior Authorization configuration claims testing of new client implementations, terminations, and criteria maintenance changes timely and accurately to mitigate the risk of member access to care issues, missed performance guarantees and potential liquidated damages.
- Acquires and maintains an expert level of understanding of Navitus’ claims adjudication system and upstream/downstream processes to test both standard and custom Prior Authorization criteria configurations to meet client expectations.
- Uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
- Completes scheduled and ad hoc audits related to system configurations for automated clinical criteria documents, within the claims and formulary management systems.
- Completes scheduled and ad hoc reports related to testing processes.
- Complies with standards set forth regarding benefit design and configuration testing including HIPAA, NCPDP and Navitus internal business standards.
- Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to complex clinical criteria-related customer questions and issue resolution requests.
- Supports internal customers by participating in client meetings, audits, and new program implementations with other areas of the company, answering clinical criteria related benefit testing questions and providing guidance to other areas and roles on the automated Prior Authorization configuration testing process.
- Adapts to industry changes and evolving technology, maintaining an expert level of understanding of both legacy and emerging products and systems.
- Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
- Other duties as assigned
Qualifications:
What our team expects from you?
- A minimum of an Associate’s Degree in a science, business, or mathematics related field, or at least two years of equivalent work experience is required
- Experience with Prior Authorization and/or testing and a “track record” of tangible success, and team collaboration/relationship-building/management is essential
- Must be able to exercise appropriate judgment
- Intermediate to advanced experience with Excel required
- Experience with pharmacy prior authorization or PBM knowledge 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!
We are 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.
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