Fraud Monitoring Jobs in Puerto Rico (NOW HIRING)

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...

As our Senior Regulatory Compliance Analyst you will be responsible for ensuring that business operations and procedures are compliant with all state and federal regulatory requirements, including HIPAA requirements, as applicable to Abarca. You will ensure that business owners receive, understand, and implement most recent federal and state regulations. You will be an independent and critical thinker, and an effective communicator. It is important that you are always up to speed on all regulations applicable to Abarca operations and delegated services!

In this position you will support the Regulatory Compliance Team, in executing Abarca's Regulatory Change Management Process, including analysis of regulatory changes, conducting training, P&P's management, and regulatory consults. You will perform a range of duties such as identifying and evaluating compliance regulations and guidance, supporting operational areas in the identification of operational impact, overseeing the implementation and documentation of new requirements, and researching and responding to regulatory consults. Also, you'll be responsible for acting as a consultative figure to our clients on regulatory topics, addressing possible changes to delegated services and regulatory questions stemming from potential audit concerns.  

The fundamentals for the job...

• Keep up to speed with all regulatory requirements and legislation, industry trends, and best practices applicable to Abarca and delegated functions.
• Continuously monitor, analyze, and assess changes in regulatory requirements, legislation, and industry trends for Commercial and Government lines of business, as well as HIPAA regulations.
• Track regulatory changes, maintain an updated regulatory log, and prepare compliance updates and summaries for internal and external stakeholders.
• Collaborate with business areas to discuss new or updated regulations and identify regulatory impact to operations or systems.
• Oversee timely implementation and documentation of regulatory changes verifying that all requirements are properly addressed, providing guidance to regulatory questions, and ensuring thorough testing and quality assurance is conducted prior to go-live.
• Participate in the Regulatory Change Management (RCM) Committee meetings, present regulatory updates and engage subject matter experts (SME's).
• Provide research and timely responses to regulatory questions from clients and internal business areas.
• Develop, update, and deliver regulatory compliance training materials and ensure all employees and delegated entities receive required training.
• Create, review, and update policies and procedures (P&Ps) to ensure compliance with state and federal regulations, contractual obligations and business operations.
• Facilitate communication and collaboration between the Compliance department and internal business units to align business processes with regulatory requirements.
• Support with privacy and security investigations as well as risk assessment process and collaborate with the Information Security Team for system security issues related to compliance. Ensure adherence to HIPAA requirements and Business Associate Agreements.

What we expect of you

The bold requirements...

• Bachelor, Law Degree, or masters degree in Health Services Administration, Public Health, Health Evaluation, or related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 6+ years of experience in Healthcare Compliance or healthcare regulatory management role.
• 3+ experience in Medicare and other government programs.
• Experience in PBM operations and/or health plan pharmacy operations.
• Experience collaborating with internal and external stakeholders.
• Experience with analysis, strategic thinking and planning skills within regulatory context.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (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.

Nice to haves...

• Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), or Certified Internal Auditor (CIA).

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.  "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.