Analyst, Tech. Operations Government Programs

Navitus Health Solutions, LLC•Appleton, WI

11d•$43,780 - $52,119•Onsite

About The Position

Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs. The role executes Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Assignments may cover a range of enrollment, reporting, claims, and reconciliation processes. The position is scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m., and may require work outside normal business hours to complete time-sensitive processes.

Requirements

Bachelor's or associate degree in a business-related field; or an associate degree equivalent and 2 years of work experience; or 4 years of work experience and a high school diploma or equivalent.
At least 1 year of work experience.
Ability to consistently interact cooperatively and respectfully with other employees.
Participate in, adhere to, and support compliance program objectives.

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. Assignments may include Employer Group Waiver Plan (EGWP) enrollment administration and oversight, retro-eligibility processes, 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 processes and update it when necessary.
Assist subject matter experts in defining and documenting process steps, and provide input on technical specification requirements.
Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance.
Communicate with Employer Groups, clients, State and Federal agencies, external vendors, and internal departments to address action items and problems, manage expectations, and support timely, accurate issue resolution.
Work outside normal business hours as needed to complete time-sensitive processes.
Perform other duties as assigned.
Participate in, adhere to, and support compliance program objectives.
Interact cooperatively and respectfully with other employees.