Supervisor, Provider Services

Due to growth we are adding a Provider Services Supervisor to our team!

The Supervisor, Provider Services is a highly motivated professional experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare. Responsibilities include the oversight for executing contracts and/or credentials with pharmacies, responding to pharmacy inquiries, and completing the tactical and operational tasks required to maintain contracted pharmacy networks. The individual(s) in this position will oversee end to end operational aspects of administration, analysis, and quality assurance for network design and management. The Supervisor, Provider Services will work closely on their daily tasks with the staff. The individual (s) is accountable for ensuring data integrity of the contracts and/or credentials entered into the pharmacy network database as well as the claims processing system adjudicate pharmacy claims according to Navitus agreements and Navitus business rules. The individual(s) will maintain and monitor the team's performance as it relates to operational duties of the department and report all performance metrics to leadership. In addition, the role of the Supervisor, Provider Services requires a deep knowledge of pharmacy processing practices, pharmacy laws and regulations, and verbal and written communication skills.

Is this you? Find out more below!

How do I make an impact on my team?

Point of contact with external pharmacy partners and strategic vendors
• Supervises functional area staff and oversees day-to-day functional area operational activities and work product including but not limited to maintenance of functional area databases; reporting requests; contract, network and credentialing updates; communications and outreach; service desk requests
• Audits internal files or systems to identify non-compliance and oversees resolution of issues found
• Oversees quality reviews of the databases (e.g. contracting, credentialing, NCRx) and functional area reports to ensure data integrity and completeness
• Monitors and extracts data from federal and/or state databases to support functional area work
• Represents functional area for external regulatory audits and financial audits
• Supports compliance with URAC, Government entities and Navitus' policy and procedures to ensure applicable quality, regulatory and organizational standards are met
• Creates and generates functional area reports (e.g. credentialing, performance guarantees, department metrics) and submits to appropriate leadership and committees in a timely and accurate manner
• Other duties as assigned

What our team expects from you?

• College or 2-year Technical Degree or equivalent experience is preferred
• CPhT preferred
• 2-5 years business-setting experience
• Retail pharmacy experience or experience in a managed care pharmacy setting desired
• Prior experience analyzing medical and/or pharmacy claims or credentials are highly desired
• Ideal candidate will be able to work independently, have telephonic and written communication skills, data-mine variable databases, analytical skills and have the ability to manage multiple priorities
• Candidate must be proficient in Microsoft applications
• Candidate must rely on knowledge of Navitus' business concepts, practices, and policies and procedures to accomplish goals
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

* Top of the industry benefits for 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% - No vesting requirement
* Adoption Assistance Program
* Flexible Spending Account

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