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MedImpact Healthcare Systems, Inc. · 1 day ago

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

San Diego, CA

Full-time, Contract

Onsite

Mid Level

$61K/yr - $101K/yr

3+ years exp

MedImpact Healthcare Systems, Inc. is a privately-held pharmacy benefit manager headquartered in San Diego, California, seeking a Bilingual Provider Relations Contract Analyst. The role involves managing relationships with pharmacies in Puerto Rico, providing education and support, ensuring compliance with network agreements, and collaborating with cross-functional teams to enhance pharmacy operations.

Health CarePharmaceutical

No H1B

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

Other duties may be assigned

Qualification

SQLData analysisBilingual English/SpanishMicrosoft AccessProject coordinationInsurance knowledgeCustomer serviceInterpersonal communicationProblem solvingTime managementPresentation skills

Required

Bilingual English/Spanish

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

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

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

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

Preferred

Previous experience as a pharmacy technician

Benefits

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

Company

MedImpact Healthcare Systems, Inc.

Glassdoor2.8

MedImpact is the nation’s largest independent health solutions and pharmacy benefit company, serving commercial health plans, government programs, self insured/employer groups, and millions of consumers.

Founded in 1989

San Diego, California, USA

1001-5000 employees