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SalaryPutting 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.
We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
The Associate I, SIU (Special Investigative Unit) will assist the Sr. Manager, Compliance and SIU and SIU Team in the execution and maintenance of the Navitus fraud, abuse and waste program, controls, and associated policies and procedures. The Associate I, SIU will initiate case files, gather necessary preliminary data to provide to SIU Investigators and make recommendations for next steps on a case referral. In addition, Associate I, SIU will perform monthly sanctions reviews, prepare and submit required FWA-related reports, assist in initial, annual and ongoing training to staff in the prevention and detection of fraud, waste and abuse and assist in developing ongoing communications to increase fraud awareness among staff and customers. Associate I, SIU will follow through on deliverables and assignments timely with limited prompting. The role requires good knowledge of pharmacy claims, billing and payment. Is this you? Find out more below!
How do I make an impact on my team?
- Assist Senior Manager, Compliance and SIU and SIU Team with the execution and maintenance of the Navitus fraud and abuse program, controls and guidance.
- Open SIU cases upon referral, assign a tracking number and initiate triage by gathering necessary data such as call notes, 3D reports, etc.
- Assign to SIU Investigator for further action on case referrals based on data gathered, line of business and availability of Investigator.
- Lead ID theft/stolen card investigations reported on members.
- Conduct monthly reviews of the OIG / EPLS sanctions list and prepare necessary documentation of reviews.
- Assist the SIU team with gathering of claims data and other FWA information for the completion and submission of client contractually required and management level reports on fraud detection activities in an accurate and timely basis.
- Maintain work instructions associate with exclusion, FWA publication monitoring, and reporting responsibilities.
- Assist in the development of fraud and compliance training for all new employees, annual re-training and ongoing training for existing employees including preparation of training materials, and tracking training activities.
- Continuously research and identify latest fraud trends; regularly monitor media (publications, web sites, etc.) and prepare communications to keep employees aware of fraud issues and trends.
- Actively participate in local, state and national organizations and events focused on fraud prevention and detection.
What our team expects from you?
- Bachelor’s Degree or a combination of education and relevant work experience is required. Must demonstrate a willingness to work towards the fraud investigator certification to qualify for increased level of responsibility and promotional opportunities. Pharmacy Technician certification strongly desired.
- A minimum of 1 year experience in pharmacy and/or healthcare claims investigations and/or auditing preferably with a Special Investigative Unit is highly desired. Knowledge of Medicare, Medicaid, and third-party payer billing regulations and reimbursement is also highly desired.
- 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?
- Hours/Location: Monday-Friday 8:00am-5:00pm, CST-Remote
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
