Regulatory Analyst

Summary

Join Abarca, a healthcare revolutionizing company, as our Regulatory Analyst! Ensure compliance with state and federal regulations for business operations and procedures. Support the Regulatory Compliance Team by executing Abarca’s Regulatory Change Management Process, including trainings and policy management. Evaluate compliance regulations, implement new requirements, and consult with clients on regulatory topics. Stay updated on regulations and legislation, monitor changes, and work with business areas to implement necessary actions. Lead the Policies and Procedures Management process, ensuring updates and proper publication. Conduct research, respond to regulatory questions, and support compliance audits and training.

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
• Availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members
• 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)
• Must be able to access and navigate each department at the organization’s facilities
• Sedentary work that primarily involves sitting/standing

Responsibilities

• Ensure that business operations and procedures are compliant with all state and federal regulatory requirements and abide by State Medicaid Plans as applicable to Abarca
• Ensure that business owners receive, understand, and abide by all federal and state regulations
• Support the Regulatory Compliance Team, in executing Abarca’s Regulatory Change Management Process, including regulatory trainings, Policies & Procedures management, and regulatory consults
• Perform a range of duties such as evaluating compliance regulations and guidance, supporting operational areas in the implementation and documentation of new requirements, and researching and responding to regulatory consults
• Act as a consultative figure to our clients on regulatory topics, addressing possible changes to delegated services and regulatory questions stemming from potential audit concerns
• 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 for those states in which Abarca processes claims
• Monitor regulatory changes and assess any potential impact of these changes in Abarca’s processes
• Work with business areas to discuss identified changes in regulation, define required actions, and ensure requirements are implemented as appropriate
• 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
• Work with operational areas to ensure that required actions derived from guidance are completed, including implementation of new processes, updating current processes, and advising on compliant operations, in accordance with applicable due dates
• Lead Policies and Procedures Management process, creating or reviewing P&P’s and ensuring that P&P’s are reviewed within required frequency, and updated with federal and state regulatory requirements, current operations, and overall business operations
• Develop a user-friendly system for maintaining the organization’s policies and procedures and ensure they are properly published to the entire organization
• Implement regular communication methods to keep all employees informed of policy and procedure updates
• Perform research and review guidance to provide timely responses to regulatory questions from clients and business areas
• Support the Regulatory Compliance Audits team with regulatory requirements and documentation
• Support in the development/update of regulatory compliance training materials. Ensure all Abarcans and delegated entities receive new hire and annual regulatory trainings. Develop ad-hoc trainings of regulatory topics as needed
• Support HIPAA investigations, specifically review and keep track of applicable federal and state requirements, including State Medicaid requirements and Client Business Associate Agreements. Act as liaison with the Security Team when system security issues are involved
• Maintain and report results on Compliance metrics and assigned Service Level Agreements

Preferred Qualifications

Preferred Certification in Healthcare Compliance (CHC), and/or Certified Fraud Examiner (CFE), and/or Certified Internal Auditor (CIA)

Benefits

Flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)