Advisor, Industry Standards

Navitus Health Solutions, LLC

1d•Remote

About The Position

Due to growth, we are adding a Advisor, Industry Standards to our team! The Advisor, Industry Standards is responsible for compliant implementation and oversight of the National Council of Prescription Drug Programs (NCPDP) Standards. This includes facilitating internal awareness of the impacts of NCPDP standard changes and their impact on the strategic vision for Navitus. The Advisor, Industry Standards, is the subject matter expert (SME) and assists in interpreting and conveying NCPDP standards to key stakeholders. This individual will actively participate in NCPDP Work Groups (WG), Task Groups (TG). This individual will collaborate, and coordinate with various internal stakeholders related to compliance of the claims adjudication system with NCPDP standards. This role requires an understanding for various Navitus business processes, knowledge of the claims adjudication platform, payer sheet requirements, identifying process improvements, and providing solutions to resolve issues. This role also requires the ability to build relationships, communicate effectively, drive decision making, gather specific business requirements and lead the execution of program enhancements to comply with industry requirements end to end. Is this you? Find out more below!

Requirements

Minimum 2 years’ work experience in PBM Operations required
PBM industry experience required
Experience in review and interpretation of complex regulatory guidance
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

NCPDP member and standards expertise with active participation in NCPDP work groups and task groups preferred

Responsibilities

Actively participate in NCPDP Task Groups and Work Groups to represent Navitus’ perspective on proposed new standards and modifications to existing standards, offering potential solutions, and seeking leadership roles when the opportunity presents itself
Engage directly with clients and auditors as a subject matter expert and strategic consultant
Develop and utilize networking relationships throughout the industry to collaborate on guidance, clarification of NCPDP standards and future development of industry standards and processes
Summarize new applicable NCPDP standards and present to Navitus leadership and departments to facilitate awareness of impacts on existing Navitus systems, processes, policies, and technology platforms
Provide subject matter expertise (SME) in support of the development of functional and business requirements for claims adjudication platform in regard to the NCPDP standards
Identifies and researches issues impacting functional area work, collaborates with internal and external customers to resolve, and oversees any corrective action required
Develop detailed knowledge of the claim adjudication system capabilities and limitations
Review prescription benefit standards changes and work internally to translate the changes into business and system requirements
Facilitate testing with pharmacies for NCPDP compliance, including development of test plans and payor sheet updates
Other duties as assigned