Analyst, Tech. Operations Government Programs

Navitus Health Solutions•Appleton, WI

10d•Onsite

About The Position

Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs. This role executes Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Assignments may cover one or more government-program processes, including enrollment, reporting, claims and encounter-data submissions, benefit coordination, error management, reconciliation, and auditing. The analyst oversees assigned process schedules and deadlines, maintains accurate documentation, supports subject matter experts in defining process steps and technical requirements, researches errors, prioritizes reconciliation, and communicates with internal and external stakeholders to resolve issues. The role may require work outside normal business hours to complete time-sensitive processes. The position is based at 1025 West Navitus Dr., Appleton, Wisconsin. The stated schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.

Requirements

Bachelor’s or associate degree in a business-related field; alternatively, an associate-degree equivalent with 2 years of work experience, or a high school diploma or equivalent with 4 years of work experience.
At least 1 year of work experience.

Nice To Haves

Experience in pharmaceutical claims adjudication systems, retail pharmacy, or a health plan organization.

Responsibilities

Execute assigned Government Programs processes accurately, efficiently, and in compliance with CMS regulations.
Administer and oversee one or more processes, which may include Employer Group Waiver Plan (EGWP) enrollment, retro-eligibility, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and claim auditing.
Oversee schedules for assigned processes, adjust schedules as needed to meet deadlines, and alert management when schedules are at risk.
Ensure process documentation reflects current procedures and update it when necessary.
Assist subject matter experts in defining and documenting process steps, and provide input on requirements for technical specifications.
Review and research errors and prioritize reconciliation efforts according to State and Federal guidance.
Communicate with Employer Groups, clients, State and Federal agencies, external vendors, and internal Navitus departments to address action items and problems, manage expectations, and ensure timely and accurate issue resolution.
Work outside normal business hours when needed to complete time-sensitive processes.
Perform other duties as assigned.
Participate in, adhere to, and support compliance program objectives.
Interact consistently, cooperatively, and respectfully with other employees.