Analyst, Medicare Audit/Reporting

Navitus Health Solutions, LLC

21h•Remote

About The Position

Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models, committed to removing cost from the drug supply chain to make medications more affordable. The company fosters an environment that celebrates diversity, creativity, and growth, encouraging new ideas and excellent service. Due to growth, Navitus is adding an Analyst, Medicare Audits/Reporting to their team. This role will be responsible for a variety of Medicare Prior Authorization Operations reports supporting the Prior Authorization Operations and may provide additional support during UM audits. The Analyst will manage all PA operations Medicare reporting requests in line with the Manager’s goals. These reports include, but are not limited to, CMS Coverage Determination (CD) and Coverage Determination Exception Request (CDER) universes, Part D Plan Reporting for Coverage Determinations and Redeterminations (CDR), Independent Review Organization (IRE) client reporting, NCQA reporting, and Timeliness and Validation Reports. Daily responsibilities involve managing report timeliness, tracking requests, ensuring regulatory compliance, overseeing PA coordinator reports, providing quality oversight and support for all Medicare D operations reports, creating new reports, identifying reporting gaps, and ensuring report accuracy.

Requirements

2 years of applicable Medicare Prior Authorization processing experience, or 2 years of Medicare reporting experience is required
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

Associate degree in business or mathematics

Responsibilities

Work with the Manager to execute goals and objectives for Prior Authorization Operations Medicare reporting needs
Execute on reporting requests, audit deliverables, monthly/quarterly Medicare reports, Ad Hoc report requests from clients and/or other internal departments, and support Manager in testing new reporting enhancements
Execute on project work associated with Navitus’ Prior Authorization Operations Medicare reporting from inception through completion
Troubleshoot for reporting issues or questions
Ensure controls are in place that adequately ensure quality in Prior Authorization Medicare report deliverables
Work with end users to suggest enhancements to the system or workflow processes to meet the needs of the business. Identify enhancement requirements for new processes, services and changes to existing processes and services to achieve department business and strategic goals
Other duties as assigned