Pharmacy Rebates Analyst
San Juan, PR · Remote
Maintain accurate records for internal auditing purposes. * Load rebate agreements accurately into ... REMOTE
Pharmacy Rebates Analyst
San Juan, PR · Remote
Maintain accurate records for internal auditing purposes. * Load rebate agreements accurately into ... REMOTE
Remote Medical Auditor information
What are Remote Medical Auditors?
Remote Medical Auditors are professionals who review and analyze medical records, billing data, and coding procedures from a remote location to ensure accuracy, compliance, and proper reimbursement. They work with healthcare providers to identify discrepancies, detect fraud, and improve documentation practices. This role typically requires strong knowledge of healthcare regulations, medical coding systems, and auditing standards. Remote Medical Auditors play a crucial part in helping organizations maintain compliance with insurance and government requirements while reducing financial and legal risks.
What are the key skills and qualifications needed to thrive as a Remote Medical Auditor, and why are they important?
To thrive as a Remote Medical Auditor, you need strong knowledge of medical coding, billing practices, and healthcare regulations, typically supported by certifications such as CPC, CCS, or CPMA. Proficiency with auditing software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is essential. Attention to detail, analytical thinking, and effective communication are standout soft skills for this role. These abilities are crucial to ensure accurate compliance, reduce errors, and maintain the integrity of healthcare billing and documentation.
What are some common challenges faced by Remote Medical Auditors, and how can they be effectively managed?
Remote Medical Auditors often encounter challenges such as staying current with ever-changing healthcare regulations, ensuring data security when handling sensitive patient information, and maintaining clear communication with healthcare providers and billing teams from a distance. To effectively manage these challenges, it's important to regularly participate in professional development, use secure digital tools for data exchange, and establish structured communication protocols within the team. Additionally, strong organizational skills and self-motivation are key to successfully navigating the remote work environment and meeting audit deadlines.
What Does a Remote Medical Auditor Do?
Most remote medical auditors specialize in medical coding and billing, which is a complex element of the industry used by insurance and care companies to help determine the care and reimbursements patients qualify for. As a remote medical auditor, you work from home to audit the records of a medical facility to ensure compliance with all regulations. In this role, you may be asked to check that bills are accurate, to perform random quality assurance tests, to provide ongoing feedback, and to answer queries from coders. Many remote medical auditors also generate quality assurance scores to evaluate coder performance and ensure a consistently high level of accuracy for coded data.
More about Remote Medical Auditor jobs
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Job description
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 our Pharmacy Rebates Analyst, you will analyze rebate proposals and model the financial impact of formulary changes. Additionally, you will analyze rebate guarantee performance and identify drivers of underperformance. You will proactively evaluate utilization and rebate data to identify opportunities to optimize rebate performance.
The fundamentals for the job...
- Support all aspects of Rebates RFP process, including all operational interactions with pharmaceutical manufacturers.
- Log and track all rebate opportunities for Abarca clients.
- Model the financial impact of formulary coverage decisions in Excel to support client formulary decision-making.
- Use SQL and Tableau to analyze utilization trends and to pull data in support of rebate modeling.
- Present rebate models to clients and client account teams.
- Notify manufacturers about client formulary decisions.
- Maintain accurate records for internal auditing purposes.
- Load rebate agreements accurately into Darwin
- Validate client formularies to ensure compliance with rebate contracts.
- Validate that rebate invoicing is accurate and consistent with our rebate agreements.
- Support clinical and client engagement teams with questions about rebate contracts and eligibility.
- Lend a hand with special projects and provide support on all company audits related to rebates billing.
What we expect of you
The bold requirements...
- Bachelor's Degree or Master's Degree in Economics, Math, Finance, Business or a related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
- 3+ year of experience in an analytical role
- Experience with Microsoft Excel
- Experience performing critical analysis of datasets, visuals and dashboards.
- Excellent oral and written communication skills.
- 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...
- Experience within the pharmacy benefit management or healthcare Industry.
- Experience with prescription drugs, pharmaceutical manufacturers, drug rebates and contract negotiations.
- Experience working with SQL and Tableau.
Physical requirements...
- Must be able to access and navigate each department at the organization's facilities.
- Sedentary work that primarily involves sitting/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.
#LI-NO1 #LI-REMOTE
About Abarca Health
Sourced by ZipRecruiter
Company size
201 - 500 Employees
Headquarters location
Miami, FL, US
Year founded
2006