Regulatory Analyst

November 20

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Abarca Health

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Pharmacy Benefit Management (PBM) • Health Business Intelligence • Health Information Technology (HIT) • Medicare • Medicaid

501 - 1000 employees

Founded 2008

⚕️ Healthcare Insurance

☁️ SaaS

Description

• Stay abreast of all regulatory requirements and legislation, industry trends, and best practices. • Keep track of regulatory changes for Commercial, Medicare and/or Medicaid, as assigned, including State Medicaid requirements. • Monitor regulatory changes and assess potential impact of these changes in Abarca’s processes. • Work with business areas to discuss identified changes in regulation and define required actions. • Participate in the Regulatory Change Management (RCM) Committee meetings and present regulatory updates. • Prepare Compliance Updates and summaries of regulatory requirements for stakeholders and maintain the regulatory log. • Work with operational areas to ensure required actions derived from guidance are completed on due dates. • Lead Policies and Procedures Management process and ensure updates of P&P’s with regulatory requirements. • Develop a user-friendly system for maintaining policies and procedures. • Implement regular communication methods on policy and procedure updates. • Perform research and provide timely responses to regulatory questions from clients and business areas. • Support Regulatory Compliance Audits team with requirements and documentation. • Support in the development/update of regulatory compliance training materials for Abarcans. • Support HIPAA investigations and act as a liaison with the Security Team for any security issues. • Maintain and report results on Compliance metrics and assigned Service Level Agreements.

Requirements

• Bachelor, Law Degree, or Master’s Degree in Health Services Administration, Public Health, Health Evaluation or related field (In lieu of a degree, equivalent, relevant work experience may be considered.) • 3+ years experience in regulatory management role within healthcare or pharmacy benefit management (PBM) industry. • Experience with Medicare. • Strong understanding of industry processes, healthcare regulations, and PBM Operations. • Excellent oral and written communication skills. • Flexible hybrid work model (Puerto Rico Location Only). • Availability to work in a specified time zone or working schedule, accommodating business needs. • On-call hours availability may be required for emergent issues or support.