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- ...and file any necessary information with regulatory agencies, if appropriate. # Monitor and interpret regulatory changes impacting PBM operations, including CMS guidelines, HIPAA, and Medicare Part D. # Assist in maintaining compliance with Medicare regulations, including...SuggestedWork at officeLocal areaWeekend workAfternoon shift
Pharmpix
Puerto Rico3 days ago - ...detail are critical to identifying root causes, communicating impacts, and driving resolution — all while building your expertise in PBM data systems and client integrations. The fundamentals for the job… Assess file load rejects and threshold limit conditions,...SuggestedWork experience placementLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
Abarca Health LLC
Puerto Rico9 days ago - ...related field. (In lieu of a degree, equivalent, relevant work experience may be considered.) ~3+ years of work-related experience in PBM industry and operations. ~ Pharmacy Technician accreditation as well as a current and active license. ~ Experience with group...SuggestedWork experience placementLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
Abarca Health LLC
Puerto Rico21 days ago - ...3. Provides orientation to pharmacies regarding pharmacy benefits. 4. Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated. 5. Assists pharmacies claim processing. 6. Assist in...Suggested
APS Health Care PR
Puerto Rico7 days ago - ...Especializada Alivia; v. Reúne toda la información y documentos necesarios para respaldar la solicitud de aprobación al Plan Médico o PBM vi. Se comunica con las compañías de seguro u otros pagadores para completar los requisitos de autorización previa, vii....Suggested
Alivia Health
Puerto Rico7 days ago - ...Puerto Rico Board of Pharmacy Technician Certification (Preferred). PROFESSIONAL EXPERIENCE ~ One (1) year experience in a PBM/Health Plan Environment (Preferred) or; Retail Pharmacy or; Proven working experience as a data analyst. PROFESSIONAL COMPETENCIES...SuggestedWork experience placementWork at officeImmediate startWeekend workAfternoon shift
- ...Access & Reimbursement and Patient Assistance Program (PAP) teams, ensuring timely, accurate, and complete processing of cases related to PBM benefits, medical benefits, PAP, copay assistance, and other applicable access programs. • Create work schedules, operational...SuggestedWork at office
- ...inform respective department heads for correction as needed. Validate contracts and reimbursement paid in the principal payors of PBM claims and inform respective department heads for correction as needed. Adjustment revenues on Alivia’s current programs for any cases...Suggested
- ...corrijan según sea necesario. Validar los contratos y los reembolsos pagados en las reclamaciones de los principales pagadores de PBM e informar a los respectivos jefes de departamento para que los corrijan según sea necesario. Ajustar los ingresos de los programas...Suggested
- ...as dictated by operational demands (if applicable). Nice to haves... ~Experience related with pharmacy benefit management (PBM) clinical operations and Medicare Part D. Physical Requirements ~Must be able to access and navigate each department at the...SuggestedSeasonal workLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
- ...In lieu of a degree, equivalent relevant work experience may be considered. ~8+ years of experience in healthcare data integration, PBM/health plan data exchange, or related roles ~ Proven expertise in SQL and relational databases ~ Experience with dashboarding...SuggestedWork experience placementLocal areaVisa sponsorshipWork visa
- ...initiative, sound judgment, confident communication, and a willingness to learn unfamiliar business processes, reports, calculations, and PBM services. You will be expected to ask thoughtful questions, use evidence to support conclusions, raise risks constructively, and...SuggestedContract workTemporary workLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
- ...support as dictated by operational demands (if applicable). Nice to haves... ~ Experience working in pharmacy benefit management (PBM) industry. Physical Requirements Must be able to access and navigate each department at the organization’s facilities....SuggestedTemporary workLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
- ...compliance with external regulatory guidelines. Independently resolve adjudication and processing issues, provide client-facing demos on the PBM configuration platform, and lead configuration setup for new client implementations and changes. The fundamentals for the job…...SuggestedLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
- ...procesos de acceso a beneficios médicos y farmacéuticos. Excelentes habilidades de comunicación verbal y escrita en español e inglés. Conocimiento de operaciones clínicas de PBM (Pharmacy Benefit Management) es preferible. Patrono con Igualdad de Oportunidades...Suggested
- ...by operational demands (if applicable). Nice to haves... Active Pharmacy Technician License is preferred. Experience in PBM, Medicare Part D, Commercial/Employer Plans, Insurance, Pharmacy, and / or healthcare. Physical Requirements Must be able to...Temporary workWork experience placementLocal areaVisa sponsorshipWork visaFlexible hoursAfternoon shift
- ...customer service with knowledge of access processes to the most preferred benefits. ~ Excellent written and verbal communications (English and Spanish) is required. ~ Knowledge of PBM clinical operations preferred. *** Equal Opportunity Employer F/M/D/V***...Contract workWork at office
