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 team takes charge by handling programs within Medicare Part D and Medicaid. Areas that GPS handles range from managing PDE accuracy by working rejects within compliant timeframes and file 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 aims to provide improvements in the development of new capabilities in support of government program compliance and audit readiness.

As a Supervisor, Prescription Data Event (PDE), you will play a crucial role in ensuring the accuracy and integrity of Prescription Drug Event (PDE) data, a critical component of Medicare Part D compliance. The successful candidate will oversee a team of analysts responsible for the day-to-day PDE processes and work collaboratively with cross-functional teams to maintain compliance with regulatory requirements.

The fundamentals for the job…

  • Oversee timely and accurate submission of PDE data while adhering to compliance requirements and service level agreements.
  • Ensure the reconciliation of PDE data to resolve any discrepancies in a timely manner.
  • Monitor and report on PDE data quality metrics and compliance within customer and CMS guidelines.
  • Communicate PDE-related issues and updates to relevant stakeholders.
  • Identify opportunities to streamline PDE data submission processes and enhance data accuracy.
  • Lead a team of PDE analysts providing guidance, mentorship, and support to ensure team success.
  • Direct and manage incoming work for the analysts as well as providing support for clients and internal requests in the capacity of a subject matter expert.
  • Set performance goals and conduct regular performance evaluations for team members.
  • Foster a collaborative and positive work environment that encourages growth and development.
  • Identify and resolve escalating issues and conflicts within the operation, project execution, or implementation.
  • Stay up to date with Medicare Part D regulations and CMS guidance related to PDE processes and data reporting.
  • Work closely with the Product and Analytics teams to implement system and reporting enhancements and improvements.
  • Develop and update Standard Desktop Procedures (SDPs) related to PDE processes.
  • Collaborate with cross-functional teams including pharmacy operations, finance, and analytics to ensure data accuracy and consistency.
  • Participate in meetings and presentations related to PDE metrics and data reporting.
  • Establish effective communication between all stakeholders.
  • Assist team during the development and testing of operational and project deliverables.

What we expect of you 

The bold requirements…

  • Bachelor's or Master’s Degree in healthcare administration, pharmacy, or a related field. Master's degree preferred. (In lieu of a degree, equivalent, relevant work experience may be considered.)
  • 6+ years of experience in roles within a health plan, pharmacy benefit management and/or related areas.
  • 2+ years in a supervisory or leadership role overseeing teams.
  • Experience with Medicare Part D regulations and CMS guidelines.
  • Experience with team management and development including task coordination, team building, and other management aspects.
  • Experience data analysis and data reconciliation withing healthcare and/or pharmacy benefit management.
  • Experience handling root cause analysis, problem solving and escalations of prescription drug events and other Medicare Part D program aspects.
  • 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.

#LI-JD1#LI-REMOTE 

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