Operations Analyst Jobs

About The Position

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.

Benefits

• Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5%
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!