Provider Relations Contract Analyst Puerto Rico

Exemption Status:

United States of America (Exempt)

$60,987 - $80,808 - $100,628

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

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.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• 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.
• Other duties may be assigned.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

BS/BA and 3+ years’ experience or equivalent combination of education and experience

Computer Skills

To perform this job successfully, an individual should have knowledge of SQL, Microsoft Access and Quest Analytics; Microsoft Office and Outlook.

Other Skills and Abilities

• 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.
• Previous experience as a pharmacy technician is preferred.

Reasoning Ability

                                   

• 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.

Mathematical Skills

     

• 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.

Language Skills

• 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.

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

Composure

Decision Quality

Organizational Agility

Problem Solving

Customer Focus

Drive for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  Work hours may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires domestic travel of up to 25% of the time. 

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.