Advisor, Industry Standards

Responsibilities

• Actively participate in NCPDP Task Groups and Work Groups to represent Navitus’ perspective on proposed new standards and modifications to existing standards, offering potential solutions, and seeking leadership roles when the opportunity presents itself
• Engage directly with clients and auditors as a subject matter expert and strategic consultant
• Develop and utilize networking relationships throughout the industry to collaborate on guidance, clarification of NCPDP standards and future development of industry standards and processes
• Summarize new applicable NCPDP standards and present to Navitus leadership and departments to facilitate awareness of impacts on existing Navitus systems, processes, policies, and technology platforms
• Provide subject matter expertise (SME) in support of the development of functional and business requirements for claims adjudication platform in regard to the NCPDP standards
• Identifies and researches issues impacting functional area work, collaborates with internal and external customers to resolve, and oversees any corrective action required
• Develop detailed knowledge of the claim adjudication system capabilities and limitations
• Review prescription benefit standards changes and work internally to translate the changes into business and system requirements
• Facilitate testing with pharmacies for NCPDP compliance, including development of test plans and payor sheet updates
• Other duties as assigned

Qualifications

• Minimum 2 years’ work experience in PBM Operations required
• NCPDP member and standards expertise with active participation in NCPDP work groups and task groups preferred
• PBM industry experience required
• Experience in review and interpretation of complex regulatory guidance
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees