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…

The Legal & Compliance department ensures our business operations and processes are compliant with all state and federal requirements. They keep Abarca updated on all regulatory and legislative developments to mitigate impact on the services we offer! They’re also the team we go to for channeling services from our external legal counsel and working on matters related to tax, audits, managing codes of conduct as well as corporate, and healthcare law.

As our Senior Regulatory Compliance Auditor, you will be responsible for ensuring successful completion of assigned audit engagements set forth in the company’s Audit Plan. You will manage and carry out operational audit activities as assigned. In this position you are also responsible for applying audit & monitoring techniques to examine documentation, interview employees, and conduct analysis of data to identify deficiencies and best practices in controls and compliance with the Center for Medicare and Medicaid Services (“CMS”) requirements as well as any other relevant agency and organizational policies and procedures. As our Regulatory Compliance Auditor, you need to be knowledgeable about the regulatory requirements that apply to the areas subject to auditing and monitoring activities as conducted under the compliance program.

The fundamentals for the job…

  • Manage the execution and documentation of all auditing and monitoring activities, according to the established annual work plan.
  • Ensure processes are followed in accordance with policies and procedures and regulatory guidance.
  • Perform analysis and trending compliance audits. Continuously evaluate specific audit/monitoring activities and determine if more formal or in-depth interventions are required.
  • Prepare clear and concise reports with the evaluations of risk, root cause, and scope of impact of the internal audit findings.
  • Develop and implement audit tools based on regulatory protocols and guidance.
  • Work with areas to identify root cause and ensure any findings are corrected promptly and documented properly.
  • Perform follow-up monitoring as required to assess improvement on findings and ensure effectiveness of corrective actions resulting from previous audit/monitoring activities as well as issue management process.
  • Act as liaison between Clients and the Company for the coordination of external audits, facilitating a responsive and responsible audit process, including corrective actions, if applicable.
  • Keep up to date with regulatory requirements and best practices.
  • Create or review any policies and procedures or training, as needed.
  • Establish and manage communication and escalation methods.
  • Serve as liaison between Compliance and Abarca business units relating to all audits performed by client or regulatory agencies.
  • Coordinate with areas for reporting requirements or audit universe submissions, including gathering reports, performing quality assurance validations and final submission to clients.
  • Other Compliance, audit, or reporting requirements activities as needed.

What we expect of you

The bold requirements…

  • Bachelor 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)
  • 6+ years of experience in compliance, regulatory and/or audits specific to Medicare.
  • Experience in Pharmacy Benefit Manager (PBM) and/ or Health Insurance (Pharmacy Side).
  • Experience in Medicare Part-D Audits, Auditing and Monitoring, CMS Program Audits & Protocols and Compliance Program Elements.
  • Experience working in collaboration with internal and external stakeholders.
  • Experience using problem solving and negotiating skills within a regulatory context.
  • Excellent oral and written communication skills, bilingual fluency in Spanish and English is required.
  • We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves…

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