Navitus

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

USD $58,460.00 - USD $70,434.00 /Yr.

M-F 8am-5pm, CT

Navitus Health Solutions is seeking a Med-D Audit Oversight Analyst to join our team!

 

This position is an Analyst, Med-D Audit Oversight SME directly responsible for conducting internal and external audits and monitoring activities for the PBM Employer Group Waiver Program (EGWP) and MA-PD/MMP Health Plan audits. The Med D Compliance Oversight Analyst (COA) will conduct quality assurance review on all audit and monitoring results. The COA will be responsible for providing monthly/quarterly audit and monitoring reports to the internal audit review committee, the Medicare Part D Oversight Committee, and business partners/clients. The COA will coordinate Process Improvement/Remediation Plans as needed. The COA will be primarily responsible for interfacing with the Government Programs Regulatory Adherence and Auditing Manager to coordinate delivery of the monthly/quarterly oversight reports, as outlined in the Audit and Monitoring work plan for EGWP. This COA will also interface with various functional teams throughout Navitus. This role requires strong analytical and auditing skills, exceptional attention to detail, strong Excel skills and deep knowledge of Medicare Part D rules, regulations, and protocols.

 

Is this you? Find out more below!

How do I make an impact on my team? 

• Responsible for assisting internal teams with CMS guidance and protocols
• Develops, implements, and maintains an audit tracking and documentation system
• Independently performs internal audits per the EGWP/MAPD audit plan according to the DWI for specific audit: Creates audit PowerPoint presentation and audit workbook and Delivers audit report presentation to EGWP client
• Assists internal departments (functional areas) in developing corrective actions/remediation as appropriate and monitors to ensure that corrective actions/remediation have been successfully implemented
• Performs regulatory and client-initiated audits: Creates FA (Formulary Administration) and CDAG (Coverage Determinations Appeals and Grievances) universes and Prepares required audit deliverables
• Prepares monthly CDAG (Coverage Determinations Appeals and Grievances) universes for designated client(s)
• Develops knowledge of what is a non-compliance event per CMS guidance and guidelines and has ability to distinguish what requires client notification
• Creates client documentation to report a non-compliant event per the established process
• Other duties as assigned

What our team expects from you?

• A Bachelor’s Degree and/or three years of relevant experience
• 3+ years’ experience and expertise in audits, facilitating process improvement, reporting, and/or operational monitoring
• Experience and expertise in Medicare Part D highly preferred
• Experience with Microsoft Excel and Office Suite products is strongly preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

 

Remote

US