Medicare Part D Program Manager

Summary

Join Abarca as the Medicare Part D Program Manager, the primary internal expert for Medicare Part D programs. You will manage key programs and processes, including Medicare Plan Finder and financial reporting. Translate guidance into business processes and system requirements, and create monitoring programs to ensure CMS compliance. Collaborate with internal teams, clients, and auditors. Develop and deliver dashboards and reporting. This role requires strong communication and analytical skills, using data to inform decisions and problem-solving. The position offers a flexible hybrid work model (Puerto Rico location only) with potential on-call hours.

Requirements

• Bachelor’s Degree or Master’s Degree in a related area. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 6+ years of work-related experience
• Experience Medicare Part D Operations, pricing and claims processes, Medicare Plan Finder (MPF) monitoring, file submissions or process development
• Experience with N transactions, Financial Information Reporting (FIR) transactions and Prescription Drug Event (PDE) processing
• Experience communicating business requirements with technical and non-technical audiences
• Experience building in and using SQL, Moderate strength in Excel functions. Experience analyzing data
• Excellent oral and written communication skills
• Must be able to access and navigate each department at the organization’s facilities
• Sedentary work that primarily involves sitting/standing

Responsibilities

• Build strong relationships by engaging directly with internal teams, clients, and auditors as a subject matter expert in Medicare Part D processes from an operational and CMS guidance viewpoint
• Identify and define enhancements to Medicare Part D processes and logics
• Translate technical and operational guidance into effective business process and system requirements
• Develop process documentation and tools for internal and external audiences
• Engage directly with clients and leadership to develop, modify, and deliver dashboards and other required reporting as needed
• Establish excellence in preventive measures and monitoring programs to ensure all client and CMS requirements are exceeded
• Prepare analysis to determine root cause, to present informatively or to inform strategy. Understands how to use data effectively to make decisions

Benefits

• 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)