Network Relations Analyst

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…

As part of our Network Strategy Provider Relations team, you will be responsible for assisting with the development and maintenance of the Provider Network and the related Pharmacy Service contracts and Agreements. You will work to ensure all our Provider Network Agreements are implemented correctly, and you will troubleshoot any network related issues for our clients and pharmacy partners. This role involves planning (i.e. pharmacy contracting), tracking, communication, and identifying and resolving issues. 

The fundamentals for the job…

• Assist with developing and maintaining pharmacy network strategies for US mainland and in Puerto Rico. Key inputs to consider type, location, and size of participating pharmacies, network size, reimbursement drivers and terms (discounts, DIR, incentives), quality criteria, and other contracting elements.
• Establish and maintain relationships with pharmacy chains and PSAOs, as well as national pharmacy organizations, i.e. NCPDP
• Serve as a point of contact for pharmacy operational questions and assist with pharmacy contracts, network maintenance, daily pharmacy enrollment requests and other relevant provider network tickets.
• Work with Legal team on creating and revising pharmacy contracting templates.
• Support and represent the development and execution of new clients, operationalize tasks associated, and deliver the highest quality of service to clients and pharmacies.
• Support the day-to-day tasks related to the pharmacy network, including triaging, and resolving issues, answering requests, creating and delivering reports on demand, and identifying opportunities for improvement.
• Use analytical tools to create and monitor network performance to ensure contract compliance and alignment with network objectives.
• Provide support to Client Engagement and Audit teams in Network related items such as directories, pharmacy education, member’s grievances, compliance, etc.
• Support Operations in the setup, configuration, and maintenance of pharmacy network requirements.
• Direct the proper storage and retention of all pharmacy documentation.
• Support day-to-day Provider Relations tasks.
• Organize and assist with pharmacy communications updates and tracking.

What we expect of you

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 professional experience, preferably within a PBM or health plan.
• Experience with contract negotiation in PBM or a related industry.
• Experience with different payer types: Commercial, Employer Groups, Health Plans, Medicare Part D, Medicaid, 340B, Discount Card.
• Experience with Pharmacy types: Retail, Long Term Care, Home Infusion, Mail Order, Specialty, Institutions.
• Experience with Pharmacy Relationships: Chains, PSAOs, Independents.
• 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)
• This position requires availability to work in a specified 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).

Nice to haves…

• Experience with analytics in terms of data tracking and analysis and project management tools.
• Experience in a Provider Relations, Chain Pharmacy, PSAO, Client Service, or a Relationship Management role,

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.  “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.