Analyst, Tech. Operations Government Programs

Navitus Health Solutions, LLC•,

2d•Remote

About The Position

Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join their team. This role is responsible for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations.

Requirements

Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent
1+ years’ work experience
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

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

Responsibilities

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)
Claim Auditing
Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk
Ensure process documentation accurately reflects the current process and update when necessary
Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications
Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance
Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution
As needed, may require working outside of normal business hours to complete time sensitive processes
Other duties as assigned