Medicare Part D Program Manager

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…

Our Government Programs and Services department is part of the Pharmacy Benefit Manager Operations and Services teams. The Government Programs and Services team is responsible for delivering successful results in Prescription Drug Event, Medicare Plan Finder, Regulatory Communications and Medicaid Encounter Data programs. We handle direct contact, data transfers, issue management and auditing for any state or federal agencies as well as government led programs.

As the Medicare Part D Program Manager, you are the primary internal subject matter expert for Medicare Part D Programs. You will manage critical programs and processes, such as Medicare Plan Finder, N Transactions, Financial Information Reporting (FIR) Transactions and more. As a Program Manager you will translate guidance into business processes and system requirements. You will also create and execute monitoring programs to ensure that Centers for Medicare & Medicaid Services (CMS) guidance is operationalized accurately and completely. In this role, you will employ your strong presentation and communication skills to work with other Abarcans and our clients to solve challenges and develop a #Betterway.

The fundamentals for the job…

• Build strong relationships by engaging directly with internal teams, clients, and auditors as a subject matter expert in Medicare Part D processes from an operational and CMS guidance viewpoint.
• Identify and define enhancements to Medicare Part D processes and logics.
• Translate technical and operational guidance into effective business process and system requirements.
• Develop process documentation and tools for internal and external audiences.
• Engage directly with clients and leadership to develop, modify, and deliver dashboards and other required reporting as needed.
• Establish excellence in preventive measures and monitoring programs to ensure all client and CMS requirements are exceeded.
• Prepare analysis to determine root cause, to present informatively or to inform strategy. Understands how to use data effectively to make decisions.

What we expect of you:

The bold requirements…

• Bachelor’s Degree or Master’s Degree in a related area. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 6+ years of work-related experience.
• Experience Medicare Part D Operations, pricing and claims processes, Medicare Plan Finder (MPF) monitoring, file submissions or process development.
• Experience with N transactions, Financial Information Reporting (FIR) transactions and Prescription Drug Event (PDE) processing.
• Experience communicating business requirements with technical and non-technical audiences.
• Experience building in and using SQL, Moderate strength in Excel functions. Experience analyzing data.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (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-CL1 #LI-REMOTE