Associate Formulary Analyst

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The Pharmacy Benefit Management (PBM) Operations & Services team is the very heart of Abarca and meets that standard by running services from medication therapy management (MTM), price eligibility, configurations, and beneficiary services to government services and beyond. The Darwin Claims Operations team handles all claims verifications, day to day configuration set-up and maintenance as well as related special projects, issue management and research for configuration.

As an Associate Formulary Analyst, you will be working closely with everything that has to do with formularies, like fulfilling basic to moderately complex formulary set-ups and change requests, researching formulary related questions, documenting basic formulary design specifications, testing, and validating formulary setups, and providing formulary related support to clients. You will also serve as a contact resource between Abarca Health and clients, as well as participate in formulary administration decisions with Client Account Management, and implementation and clinical groups based on criteria established by the department.

The fundamentals for the job…

• Formulary Maintenance including verifying medication reports, new national drug codes (NDCs), expired drugs to determine if formulary changes should be made.
• Verify and evaluate the Medicare reference formulary to analyze if there are possible inclusions or exclusions on Company created formularies.
• Collaborate with cross-functional teams to receive, update, and translate formulary reports, marketing materials, and prior authorization criteria.
• Provide timely support to other areas to verify and analyze claims processing cases, and other operational situations and issues referred for validation.
• Support urgent adjudication and processing issues including doing research, analysis, identification of root cause, impact analysis determination and corrective action.
• Perform Quality Control and Quality Assurance functions to assess information accuracy in all Formulary Management processes.
• Stay current with external regulator guidelines to make timely adjustments to operations ensuring our processes follow rules and regulations.
• Formulary setup for new Medicare, Commercial and Employer client implementations, and process changes for existing clients.

 What we expect of you:

The bold requirements…

• Associate or bachelor’s degree in a related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 3+ 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.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)
• Bilingual fluency in Spanish and English is required.

Nice to haves…

• Experience or coursework in expanded benefits and/or insurance industry.
• Experience with PBM clinical operations and Medicare Part D regulations.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”.

All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

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