Abarca Health · 2 days ago

Senior Regulatory Compliance Analyst

United States

Full-time

Hybrid

Senior Level

6+ years exp

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Responsibilities

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.

Qualification

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Healthcare ComplianceRegulatory ManagementMedicarePBM OperationsHealth Plan Pharmacy OperationsStakeholder CollaborationProblem-SolvingStrategic ThinkingCommunicationFraud ExaminationInternal AuditDepartment Navigation

Required

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