Sr. Administrator, Pharmacy Reimbursement

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Work Schedule Description (e.g. M-F 8am to 5pm)

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Hiring Manager : Full Name: First Last

Overview

Due to growth, we are adding a Sr. Administrator, Pharmacy Reimbursement to our team.

The Sr. Administrator, Pharmacy Reimbursement is responsible for executing and validating pharmacy reimbursement processes across adjudication, financial systems, and downstream data environments to ensure accuracy, compliance, and operational integrity. This role serves as a key technical and operational resource supporting the translation of pharmacy contractual terms into system configuration and the validation of reimbursement outputs across integrated platforms, including adjudication systems and enterprise financial systems (e.g., Oracle Fusion).

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

• Act as a Payments Team SME (subject matter expert) for internal and external clients.
• Play a primary role in developing training on new or existing procedures and provides training to team members.
• Support execution, quality and validation of pharmacy payment processes within Oracle Fusion, including invoice alignment, remittance outputs, and reconciliation inputs.
• Assist in identifying, remediating and resolving discrepancies between claims adjudication outputs and ERP financial transactions.
• Participate in user acceptance testing (UAT) and regression testing for Fusion-related enhancements impacting pharmacy reimbursement workflows.
• Perform root cause analysis of data discrepancies across adjudication, remittance (835), and financial systems.
• Partner with IT and Data teams to document data mappings, controls, business rules, and transformation logic impacting reimbursement.
• Support development and maintenance of data dictionaries and metadata for reimbursement-related datasets.
• Identify, document, and escalate variances in payment accuracy, timing, and completeness.
• Maintain audit-ready documentation supporting payment accuracy, recoveries, and reconciliation processes.
• Support implementation of workflow improvements across billing, remittance, and reconciliation processes.
• Participate in cross-functional initiatives to improve cycle time, reduce errors, and enhance payment transparency.
• Develop and implement standardized procedures and controls supporting scalable reimbursement operations.
• Analyze reimbursement trends and identify anomalies requiring investigation.
• Support Finance and leadership with data insights for accruals, audits, forecasting inputs, and financial reporting.
• Lead investigation, research and resolution of complex payment discrepancies and pharmacy inquiries.
• Other duties as assigned.

Qualifications

What our team expects from you?

• Associate’s degree in Healthcare Administration, Business, Finance, Information Systems, or a related field, or equivalent work experience, required. Bachelor’s degree preferred.
• Certification/Licenses: CPhT certification preferred.
• 3+ years of experience in PBM, managed care, healthcare operations, or a related field with exposure to claims processing, reimbursement, or payment-related functions required.
• Previous testing experience is required.
• Coursework or experience in financial systems (e.g., ERP platforms such as Oracle Fusion), data analytics, or healthcare information systems preferred.
• 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
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

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