Analyst, Tech. Operations Government Programs

Navitus Health Solutions, LLC•,

7d•$43,780 - $52,119•Remote

About The Position

Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team! The Analyst, Tech. Operations Government Programs has responsibility 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

Execute Government Programs processes accurately, efficiently, and in compliance with CMS regulations.
Administer and oversee Employer Group Waiver Plan (EGWP) enrollment.
Manage Retro-eligibility processes.
Handle Financial Information Reporting (FIR).
Manage Plan Finder Submission.
Oversee Coordination of Benefits (COB).
Manage Reject Management.
Manage Prescription Drug Event (PDE) error management and reconciliation.
Handle Medicaid Encounter Data.
Manage Affordable Care Act (ACA) Claims Submission.
Process Explanation of Benefits (EOB).
Manage Retiree Drug Subsidy (RDS).
Perform Claim Auditing.
Oversee schedules for assigned processes, adjust as necessary to meet deadlines, and alert management when schedules are at risk.
Ensure process documentation accurately reflects current processes and update as 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.
Communicate effectively 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.