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.

Abarca’s Government Program Services (GPS) team takes charge by handling pharmacy benefit related programs within Medicare and Medicaid. Areas that GPS handles range from managing PDE accuracy by working rejects within compliant timeframes, submissions for Encounters and Plan Finder. The team leverages their deep understanding of Medicare Part D & the Medicaid Market regulatory environment to support different business areas such as PBM Operations, Compliance, Benefit Configuration, Product Strategy, and Service Delivery. The GPS team seeks to develop improved capabilities in support of government program compliance and audit readiness.

As a Data Analyst within this specific faction of GPS, you will play a crucial role in ensuring the accuracy and procedural integrity of the operations supporting Encounter data management for multiple Medicaid business lines. The successful candidate will be part of the GPS Medicaid Encounters Team which is responsible for the implementation, and stabilization, of day-to-day processes that support Medicaid Encounters. This role will also work collaboratively with cross-functional teams to maintain compliance with regulatory requirements and adhere to multiple service model relationships with clients.

The fundamentals for the job…

• Monitor and analyze timely and accurate execution of Government Programs Encounter data processes while adhering to compliance requirements and service level agreements.
• Ensure the resolution of any errors affecting Encounter processes in a timely manner.
• Monitor and report on quality metrics and compliance within customer and applicable guidelines.
• Communicate Government Programs-related issues and updates to relevant stakeholders.
• Receive and process client and internal requests in the capacity of an Encounter data subject matter expert.
• Actively participate in a collaborative and positive work environment that encourages growth and development.
• Provide technical and analytical support for escalating issues and conflicts within the operation, project execution, or implementation of Encounter processes
• Stay up to date with applicable regulatory guidance related to state Medicaid processes.
• Work closely with the Product and Analytics teams to implement system and reporting enhancements and improvements.
• Participate in meetings related to Encounter data reporting of new and stabilized lines of business
• Provide support during the development and testing of operational and project deliverables.

What we expect of you

The bold requirements…

• 3+ years of experience working with Medicaid and/or MMP Encounter data.
• Experience working within a health plan, pharmacy benefit management and/or related areas.
• Experience running queries with structured query language (SQL).
• Knowledge of pharmacy claims processing elements. Pharmacy Technician license with input experience is a bonus.
• Experience analyzing Medicaid and state guideline documents, including formatting requirements, multiple states preferred but not necessary.
• Experience with data analysis and data reconciliation within healthcare and/or pharmacy benefit management. MMIS vendor experience is acceptable as substitution or complement to this requirement.
• Experience researching and providing findings that support root cause analysis, problem solving and escalations of relating to Encounter management.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

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.  “Applicant must be a United States’ citizen. 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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