Provider Payments Specialist
Abarca Health, LLC
 San Juan, PR

What you’ll do

In a few words…

They say everyone is special, but not everyone is a Specialist. Specialists are experts in their field, and you are precisely that: An expert in payments. And lets face it, when it comes to payments, everybody has questions, so the payment specialist’s job is to be the go-to person for pharmacy payments inquiries triage. That includes validating claims payment, helping with explanations of payment inquiries, providing requested reports, and clarifying general payments questions. There’s more, but that’s the bulk of it. As a Provider Payment Specialist, you will have direct communication with pharmacies, third party providers, pharmacy services administration organizations, and Abarca’s clients. Also, you will manage the configuration related to pharmacy payments and payment methods.

The fundamentals for the job…

  • Manage any pharmacy concerns and ensure resolution and satisfaction related to payments and remittance advices, among others (Like a superhero, you shall be.)
  • Provide accurate and complete responses to pharmacies, third party providers, and pharmacy services administration organizations, regarding payment inquiries.
  • Provide support to the Network Strategy team
  • Work in partnership with the Darwin configuration team in matters related to Network
  • Support the Network Strategy team with client implementations and other special projects (You’re the column that hold our ceilings up.)
  • Manage changes in payment configuration to pharmacies including bank accounts, central payment, among others.
  • You will assist in the development of ad-hoc analyses and reports, including market trends, performance, KPI and pharmacy specific analyses, and provide information efficiently and promptly (We’ve tried inefficiently and late, and it just doesn’t work.)
  • Help with documenting reporting requirements for Business Intelligence to create new operations reports that will allow the Finance Operations team to conduct their work more efficiently and assist in decision-making.
  • Support providers with contract management and maintenance
  • Support the Finance Operations Analysts with other tasks as needed
  • Provide client support and/or compliance/audit activities and collaborate in special projects and activities as assigned

What you’re made of

The bold requirements…

  • Bachelor’s degree in Business Administration, Finance, Science, Health, Pharmacy Technician. or a related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
  • 1-2 years of experience in a Pharmacy Network Management, Client Services, or Relationship Management role would be preferred over something like 0 experience or 6 months of it.
  • Experience in auditing and/or accounting would be even better. Like putting icing on the cake or whip cream in your coffee.
  • Excellent presentation skills (Those beautifully animated Power Points make you shine!)
  • Having knowledge of the Healthcare, Pharmacy, and Pharmacy Benefit Management industries, Medicare Part D, and CMS regulations would make you a better candidate; one we would tag with happy face stickers.
  • Able to generate analysis and reports, utilizing Excel and other tools (What good is a presentation without some charts and reports?)
  • You should be a client and detail-oriented problem solver, able to quickly spot trends and discrepancies, with strong analytical thinking skills.
  • Your computer proficiency with Microsoft Office products should be Bill Gates level, and your Internet surf experience could qualify you for the Pipeline Pro.
  • You can communicate effectively (read, write, speak, panic about COVID-19, argue, flatter, post to social media, use proper Emojis, etc.) in English and Spanish.

Nice to have… (This is the equivalent of putting on a new pair of glasses with a slight improvement in vision. Unnecessary, but oh, it makes it so much better!)

  • Pharmacy Technician license

That something extra we´d love to see…

  1. Integrity: You don’t have a single dishonest or disloyal cell in your body. Down to the marrow, you can be trusted. This applies to everything about you in every area. That’s because you’re loyal and honest down to your very DNA. Some people can find this quality boring, but it’s as rare as element 115 and just as precious.
  2. Analytical & Strategic Thinking: Perhaps we should include the word “over” in this description, because you basically over-analyze ever minute detail of absolutely everything to the point of exhaustion. That goes for your planning too, which is why you’re always 3 steps ahead of the game. (Excel spreadsheets for vacation schedules are a bit extreme, though.)
  3. Adjustable - Like a one-sized belt, you can adjust to any situation with ease. You know circumstances and priorities are always changing which is why you love to put dimmers on your lights.
  4. Negotiator: Your communication and negotiation tactics are sharp. You’re the type of person that can talk their way out of anything. The FBI calls YOU when they need a negotiator. You have a certain aplomb that can take control of a situation and make decisions.
  5. Responsible/Accountable: You’re one of the most, if not THE most reliable person in the room. You own up to what you say and do, and correct things when you make mistakes. Honesty and loyalty are your most prized assets.

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is absolutely not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.