Analyst III, Network Configuration

Navitus Health Solutions, LLC•,

3h•$54,236 - $64,567•Remote

About The Position

Navitus Health Solutions is seeking an Analyst III, Network Configuration to join their team. This role ensures efforts align with the Provider Services team to leverage technology and process improvement for meeting business needs by accurately administering networks. The Analyst III, Network Configuration configures pharmacy networks in the claim adjudication system based on specifications from internal customers and external clients. This role applies knowledge of highly diverse networks across multiple lines of business, ensuring that claims adjudicate accurately and timely. The Analyst III, Network Configuration will work closely with several Navitus departments including, but not limited to, Account Management, Claim Adjudication Operations, Formulary Operations, and Information Technology to ensure Navitus is able to provide a versatile adjudication system that allows for various pharmacy network designs and accurate claim adjudication to adapt to the continuous changes in the pharmacy benefit industry. This position may include after-hour and/or weekend hours with other eligible team members depending on workload.

Requirements

Associate’s degree or equivalent work experience required.
Strong knowledge of Navitus systems and processes of the role with ability to perform tasks independently and follow instructions to make decisions required, typically with 2-3 years of experience.
Experience with guiding and educating associates within current to lower-level roles.
Experience with supporting mid-sized to large clients with moderate to high complexity.
Experience with supporting health plan business with minimal guidance.
Experience with the following tools at an intermediate to advanced level: Navi-ClaimRx, Microsoft Office (Word, Excel, PowerPoint), Formulary Management, Request Management (Connectus, Service Desk, Responsive), Government Programs Error Management (GEMS), Reporting (3D QlikView/QlikSense).
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

Complete scheduled and urgent configuration of new client implementations and/or network additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees, and potential liquidated damages.
Acquire and maintain an advanced level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations.
Comply with standards set forth regarding network design and configuration including HIPAA, NCPDP, and Navitus internal business standards.
Perform quality assurance peer reviews of network plan additions and changes with a high degree of accuracy. Research root cause of issues, troubleshoot viable resolutions, and make recommendations for corrective action.
Use departmental workflow management, issue resolution, and reporting tools for troubleshooting and responding to highly complex customer questions and issue resolution requests.
Support internal customers by participating in client meetings, audits, and new program implementations with other areas of the company, answering network setup questions and providing guidance to other areas and roles on the network configuration process.
Adapt to industry changes and evolving technology, maintaining an advanced level of understanding of both legacy and emerging products and systems.
Lead process improvement, cost reduction, and automation efforts. Independently assess future business needs and bring recommendations to leadership.
Contribute to the creation and ongoing maintenance of departmental training materials, work instructions, and policies. Provide support for client and sales presentations and respond to assigned RFP questions using subject matter expertise.
Other duties as assigned.