Bilingual Provider Relations Contract Analyst (on-site in Puerto Rico)

MedImpact•San Diego, CA

6d•$60,987 - $100,628•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Summary The ideal candidate will be Bilingual English/Spanish and based in Puerto Rico The Provider Relations Contract Analyst Puerto Rico is responsible for relationship management with pharmacies in support of plan sponsors, strategic initiatives and operational projects, pharmacy network contracting efforts and processes, and pharmacy network operations.

Requirements

BS/BA and 3+ years’ experience or equivalent combination of education and experience
To perform this job successfully, an individual should have knowledge of SQL, Microsoft Access and Quest Analytics; Microsoft Office and Outlook.
Working knowledge and understanding of Insurance, pharmacy and/or healthcare contracting and/or claims experience.
Data query, data analysis and presentation skills
Project coordination experience within a corporate environment coordinating multiple teams with constant deadlines and driving project processes.
Strong written and in-person communication using clear, simple language that all stakeholders can understand.
Previous experience working directly with customers and good presentation skills.
Ability to work independently and support project / issue resolution.
Candidate must be fluent in English and Spanish
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of organization.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Nice To Haves

Previous experience as a pharmacy technician is preferred.

Responsibilities

Regularly visit Puerto Rico pharmacies to forge a connection and build trust
Work with pharmacies to provide education and support on pricing, credentialing, recredentialing, attestations, and any other network related activities
Assist Account Management in client plan benefit and network preparation with area pharmacies
Prepare, schedule, and present at quarterly pharmacy meetings
Review pharmacy contract setup to ensure compliance with pharmacy network agreements
Support pharmacy audits and network compliance initiatives
Support daily credentialing, re-credentialing, and contracting operations
Implement changes to ensure compliance with all company policies and procedures as well as regulatory requirements
Research and problem solve to resolve claim issues and concerns
Respond to and track requests, inquiries, and communications with network pharmacies
Collaborate with cross-functional teams on pharmacy-related matters
Develop, review and distribute pharmacy communications to meet internal and client requests
Investigate specific issues related to regulatory requirements through literature or internet resources
Resolve dissatisfaction among providers within limits of authority
Maintain current provider data to ensure the quality of the network
Run reports and support data analysis to produce meaningful and actionable results to answer key business questions
Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures
Track project tasks and deliverables to ensure timelines are met
Collaborate with Implementation Managers on specific project assignments