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…

From managing day-to-day pharmacy network operations, developing standard reporting, to crafting pricing and underwriting strategies, our Drug Value Strategy team is critical. The Senior Data Analyst is part of the Data Analytics team who drives the standardization and creation of Data Metrics reports using raw data to supply updates for audits, predictive models, and identify potential operational and clinical opportunities for both internal and external use.

As our Senior Data Analyst for Government Programs, you will be responsible for supporting our compliance program effectiveness through data analysis to identify risks and trends using data visualization and dashboards.  This may include generating ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and scripts. You will become a subject matter expect, proactively identifying the applicable regulation changes for Abarca, generating, and disseminating the data needed for analysis, as well as supporting the Regulatory Compliance Team and department leadership in making key policy decisions aimed at proactively mitigating risk and potential audit concerns. 

The fundamentals for the job…

• Understand data sources and the data to complete the reports and analyze the data with management.
• Execute departmental reports at the required frequency with implemented quality check workflows.
• Analyze and review data on a regular basis to ensure compliance and consistency.
• Communicate data outliers to business owners (internal and external), leadership and Government Programs management.
• Complete ad hoc reporting/queries as needed as part of external audits.
• Develop working understanding of organizational structure to enhance our regulatory compliance program.
• Work with business areas to discuss identified changes in regulation, define required actions, and ensure requirements are implemented as appropriate.
• Perform data analysis and validation to ensure required accuracy and specifications.
• Participate in the Regulatory Change Management (RCM) Committee meetings, presenting regulatory updates and engaging participation of subject matter experts (SME’s).
• Prepare Compliance Updates and summaries of regulatory requirements identifying required actions, for internal and external stakeholders and maintaining updated Abarca’s regulatory log.
• Perform research and review guidance to provide timely responses to regulatory questions from clients and business areas.
• Lead conversations with clients around regulatory requirements and any impact to the organization, including any potential audit concerns.
• Support in the development/update of regulatory compliance policies and procedures as well as training materials aligned with government regulations.
• Support HIPAA investigations, specifically review and keep track of applicable federal and state requirements, including State Medicaid requirements and Client Business Associate Agreements.

What we expect of you

The bold requirements…

• Bachelor’s degree in business, healthcare, or related field (In lieu of a degree, equivalent relevant work experience may be considered.) 
• 6+ years of experience in Healthcare Compliance and/or regulatory role.
• Strong understanding of industry processes, PBM Operations and Medicaid regulations.
• 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)

Nice to haves…

• experience with Medicaid or Medicare regulations 
• Certified in Healthcare Compliance (CHC), and/or Certified Fraud Examiner (CFE), and/or Certified Internal Auditor (CIA)
• Proficiency with at least one of the Microsoft Business Intelligence stack tools: MS SQL Database.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

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.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”.

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.

 #LI-JD1 #LI-REMOTE