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…From managing day-to-day pharmacy network operations, developing standard reporting, to crafting pricing and underwriting strategies, our Drug Value Strategy team has us going! Our Drug Pricing & Underwriting Strategy folks participate in client negotiations to establish rebates with key industry players while also creating attractive and lucrative pricing strategies and formulary recommendations for potential clients.As our Credentialing Analyst, you will make sure everything is correctly set regarding paperwork and credentials.
You will focus on elevating quality and compliance standards for network providers and third-party vendors engaged by Abarca, providing the administrative, analytical, and technical support necessary for the operation, and functioning of their credentialing and verification processes. You’ll use keen attention to detail and unprecedented integrity to process credentialing applications and required verifications as per applicable regulations and internal policies and procedures. As such, you will maintain and update the credentialing database for network providers and third-party vendors engaged by Abarca.The fundamentals for the job…
- Serve as a subject matter expert (SME) of the credentialing and recredentialing processes within the pharmacy network.
- Conduct ongoing credentialing and re-credentialing processes and ensure compliant and timely revision of all relevant applications.
- Review and ensure that all necessary licenses and credentials are verified and timely updated. This might include contacting licensing boards, reviewing enrollment applications, and obtaining information directly from providers.
- Ensure compliance with State and Federal regulations, especially those that apply to credentialing and CMS Stars Rating Program.
- Support Network Strategy team on issues and resolutions related to credentialing, contracting, enrollment, and termination of providers within the pharmacy network.
- Assist and maintain collections of data, tracking, and reporting for credentialing and third-party vendor in accordance with internal policies and procedures.
- Maintain cooperation and compliance with all regulatory and accrediting organizations.
- Create plans of action for assigned projects, including but not limited to workflow and quality improvements.
- Assist in the development and delivery of trainings related to credentialing and third-party oversight initiatives.
- Document activities, interventions, and issue resolutions according to internal policies for providers and third-party vendors.
- Assist with Network Strategies- Provider Relations projects and with training to other staff members.
- Assist with Pharmacy Complaints and Grievances as well as Medicaid Provider Enrollment
What you’re made of
The bold requirements…
- Bachelor’s Degree or Master’s Degree in a related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
- 3+ years of experience in Credentialing or Pharmacy Network Management.
- Experience developing and maintaining effective relationships with providers.
- Experience maintaining high level of confidentiality.
- Excellent oral and written communication skills.
- We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
Nice to haves…
- Experience with Medicare Part D and Medicaid.
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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