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 a 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…Facilitate the review, analysis, and submission of new pharmacy formulary designs for approval to the appropriate decision maker (internal/external) and set-up of the approved formulary designs into RxPlatform.Coordinate and lead formulary design reviews with internal and external clients to ensure accurate set-up of pharmacy formularies.Manage review of all pharmacy formulary test claims to validate that formularies are set up to charge the correct pharmacy cost share which impacts patients and clients.Stay current with making timely adjustments to operations ensuring our processes follow Medicare Part D’s rules and regulations.Assist in the review of pharmacy formulary audits from the PBMs and assist in any remediation.Assist in coordinating all required documentation for compliance with stated departmental Policy and Procedures.Help with RFIs and RFPs when formulary data is required.Act as a client support resource while participating as a member of the formulary team.Support the development and maintenance of documentation for formulary education and training purposes.Work cross-functionally to properly carry out changes, evaluate impact of new system requirements and assist in the design and execution of test scripts.Understand and document system logics and processes, as well as create and conduct training on them.Evaluate and analyze Form process requirements to make recommendations for improvements.Perform client or prospect client facing to present demos around the PBM configuration platform.Provide onboarding and training to the Formulary Analysts staff as well as other staff within Abarca. What we expect of youThe 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 work-related experience in PBM industry and operations.Pharmacy Technician accreditation as well as a current and active license.Experience with group benefits, services, and programs.Experience writing so requirements, expectations, results, and conclusions are read easily.Experience with established PBM Technology Companies.Experience applying professional presence and business acumen to effectively manage clients, prospects, partners, and vendors.Experience with basic statistics and management reporting.Excellent oral and written communication skills. Bilingual fluency in Spanish and English is required.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 or coursework in expanded benefits and/or insurance industry.Experience with 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. 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.