Associate Formulary Analyst

Summary

Join Abarca, a healthcare revolutionizing company, as an Associate Formulary Analyst. You will configure and implement formularies across various clients, conduct testing, and perform quality assurance. Responsibilities include resolving adjudication issues, collaborating with other units, and tracking requests. A basic understanding of external regulator guidelines is needed. You will also provide process feedback and support knowledge article creation. The role requires a degree or equivalent experience, pharmacy technician accreditation, and relevant experience. A flexible hybrid work model is offered, but availability for specific time zones and on-call hours may be required.

Requirements

• Associate or Bachelor’s degree in a related field (In lieu of a degree, equivalent, relevant work experience may be considered)
• 1 + years of experience in a healthcare non-retail pharmacy setting within a similar or related role
• Pharmacy Technician accreditation as well as a current and active license
• Experience with areas of clinical expertise
• Experience applying customer service and presentation skills within clinical operations
• Excellent oral and written communication skills

Responsibilities

• Execute standard formulary setups for new Medicare, Commercial and Employer client implementations, and process changes for existing clients
• Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation
• Conduct design review of peers on the proposed build design and configuration peer review
• Perform Quality Control and Quality Assurance functions to assess information accuracy in all Formulary Management processes
• Support the research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action
• Apply appropriate sense of urgency support to other areas to verify and analyze claims processing cases, eligibility, and other operational situations and issues referred for validation within SLAs/SLOs
• Collaborate and coordinate with other business units to execute configuration as required
• Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met
• Basic understanding of external regulator guidelines such as Medicare, Medicaid, and state requirements, to make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations
• Provide feedback on processes and make recommendations for improvements
• Support analysts in creating new knowledge articles related to formulary topics

Preferred Qualifications

• Experience or coursework in expanded benefits and/or insurance industry
• Experience with PBM clinical operations and Medicare Part D regulations
• Bilingual fluency in Spanish and English oral and written skills

Benefits

• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)
• This position requires availability to work in a pacific time zone or working schedule, accommodating the business needs of our clients and team members
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable)