Associate Financial Operations 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…

As a Financial Operations Associate Analyst, you will play a crucial role in supporting the client billing process, managing provider and member payments, handling pharmacy price appeals, and ensuring compliance with contractual obligations. Your responsibilities will also include working on financial reports, supporting Medicare reporting requirements, and contributing to special projects aimed at enhancing Abarca Health’s financial performance. Additionally, you will address pharmacy payment inquiries that require triaging, which involves validating claims payments, explaining payment inquiries, providing requested reports, and clarifying general payment questions. This role involves direct communication with pharmacies, third-party providers, pharmacy services administration organizations, and Abarca’s clients. You will also be responsible for configuring pharmacy payments and payment methods. We are committed to fostering an inclusive and innovative work environment where every team member can thrive. We offer flexible work models and encourage professional growth and development.

The fundamentals for the job…

• Billing and Payment Processes: Execute client billing and provider payment processes, manage invoice submissions and payment issuances, oversee Direct Member Reimbursements (DMRs), execute changes in payment configuration to pharmacies including bank accounts, central payment and address and resolve billing and payment inquiries.
• Compliance and Appeals: Ensure compliance with timeliness requirements for pharmacy appeals, handle pharmacy appeals, and support client and pharmacy concerns.
• Financial Analysis and Reporting: Identify opportunities for process improvement, review and analyze financial discrepancies, contribute to Medicare reporting requirements, and support other reporting requirements for various business lines.
• Cross-Functional Collaboration: Collaborate with other departments to address financial reporting needs and provide support to different departments such as, but not limited to the Product Network Strategy, Product, Software Engineering, Analytics, Data Warehouse, Data Exchange and Darwin configuration team.
• Special Projects and Ad-Hoc Analyses: Assist in the development of ad-hoc analyses and reports, document reporting requirements for Business Intelligence, and support special projects and activities.
• Client and Pharmacy Support: Provide accurate responses to pharmacies, third party providers, and pharmacy services administration organizations and clients.

What we expect of you

The bold requirements…

• Bachelor’s degree in accounting, Business Administration, Finance, Pharmacy Technician or a related field (equivalent relevant work experience may be considered).
• 1+ years of experience in Pharmacy Network Management, Finance, Analytical, Client Services, Auditing or Health Industry roles.
• Proficiency in working with financial reports and data analysis tools such as Microsoft Excel, Tableau or similar reporting and analytics tools.
• Strong attention to detail, with a proven ability to identify and resolve financial discrepancies.
• Experience with client-facing issue management effectively.
• Excellent oral and written communication skills, bilingual fluency in Spanish and English is required.
• We are proud to offer a flexible hybrid work model, with on-site work required at our Puerto Rico location.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable). 

Nice to haves…

• Current and Active Pharmacy Technician License.
• Experience with Pharmacy Benefit Management industries, Health Insurance Claim Processing, Medicare Part D and CMS regulations.
• Experience or knowledge working with SQL.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Primarily sedentary work, with frequent sitting or 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.  “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.
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