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 PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM to price eligibility to government services and beyond. Our beneficiaries' every concern is satisfied whether it be for a prior authorization, script concern or case management follow up. They're not just an operations team as they also set strategy for new clinical programs based on accurate data. Collaboration is also key as they work with teams like Software Development to design quality processes that meet client requirements, test our systems, and ensure benefits and claims are configured and processed correctly!
As a Medicare Part D Letter Analyst, you will be tasked with conducting investigations and resolving complex issues via strong analytical and communication skills. We’ll rely on you to execute and monitor letter processes for Medicare Part D business including EOBs, Transition, Formulary Negative Change, OIG Exclusion, Provider Preclusion Letters, and more. Grasping new concepts and acquiring platform knowledge through independent study, as well as interaction with other team members, will be essential here. The ability to discuss technical logic, awareness of when to be detailed, and assurance evoked through extensive understanding of our solutions and technology is also a key part of this role!
The fundamentals for the job…
- Monitor Part D letters and dashboards; identify and initiate error resolution as necessary.
- Analyze pharmacy claims, formulary, provider data, and pricing changes and determine how those affect downstream letters.
- Track, trend, and monitor issues as they arise.
- Understand and reference guidance when analyzing and resolving issues.
- Identify and proactively suggest process improvements.
- Document and explain observations to technical and non-technical audiences.
- Provide guidance and solid understanding of Medicare Part D processes the impact letters.
- Assist in new client implementations and existing client re-implementations to ensure accurate letter logic and content.
- Locate, read, understand, and apply CMS guidance to processes as necessary.
- Understand and execute the quality assurance checks on Medicare Part D processes and communications.
- Review inbound and outbound data files, utilize reports to ensure Medicare Part D process accuracy in various business functions.
- Stay up to date on CMS guidance related to Medicare Part D products.
- Provide client support and/or compliance/audit activities and collaborate in special projects and activities.
What we expect of you
The bold requirements…
- Bachelor’s degree in a related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
- 3+ years of combined or relevant work-related experience.
- Experience with Medicare Part D processes within a pharmacy benefit manager or health plan.
- Ability to analyze data, reports, and findings to discern patterns and discrepancies.
- Problem solving and analytical skills that are applicable to role processes and procedures.
- Ability to thrive in a high-growth, fast-paced, complex, shifting, and uncertain business environment.
- Highly organized and self-motivated to run and complete important investigations simultaneously.
- 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).
Nice to haves…
- Experience with pharmacy paid claim calculations and accumulators is strongly preferred.
Physical requirements…
- Must be able to access and navigate each department at the organization’s facilities.
- Sedentary work that primarily involves sitting/standing.
At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
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”
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.
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