Admissions Specialist I - Avera Specialty Hospital at Abarca Health

Sioux Falls, South Dakota, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

High School education (inferred from "Required Education" section, text cuts off)
Visual acuity adequate to perform position duties
Ability to communicate effectively with others
Ability to hear, understand, and distinguish speech and other sounds
Ability to work rotating days/evenings/nights/weekends, primarily Monday-Friday 6am-2:30pm (occasional evenings/weekends)

Responsibilities

Register patients in a timely and accurate manner by entering demographic, insurance, physician, and other defined information while following established registration standards
Assist Patient Care staff with bed assignments based on patients' diagnosis, age, and condition
Monitor the quality and efficiency of the registration process, including completing follow-up on incomplete registrations through bedside registration
Generate patient estimates, educate patients on their plan benefits at time of service or pre-call, and identify specific account goals for collection based on deposit matrix/patient estimator tools
Request and accept deposits towards deductible and/or coinsurance amounts from patients based on current deposit matrix/patient estimator tools and post payments correctly to the payment processing system
Verify insurance coverage and limitations, and collect patient co-payments, deductibles, and out-of-pocket expenses; communicate this to the patient
Complete insurance verifications, pre-certification, and/or authorization for assigned accounts
Maintain positive customer relations as evidenced by feedback from patients, visitors, physicians, patient care units, and fellow employees
Ensure all patients are offered a Patient’s Rights Brochure, understand the admission consent form, and are informed of the hospital’s privacy practices (HIPAA)
Coordinate internal hospital messages, import continuity of care documents (CCDs), and answer telephone promptly and courteously, immediately addressing caller’s needs
Interact with patients in Patient Care units to complete registration (obtaining consents, informing of telephone consumer protection act, insurance information, referring physicians, and CMS required documentation such as IMMs, MOON, and OBVs)
Check for medical necessity by confirming CPOM order and status of care at time of admission for direct admits
Perform all necessary procedures to create accounts/medical record numbers and handle insurance coverage/limitations in a timely and accurate manner; coordinate communication with patients, employees, providers, and external financial agencies

Skills

patient registration

insurance verification

demographic data entry

patient estimates

bed assignment

pre-certification

authorization

point of care collection

insurance coverage verification

medical record management

Abarca Health

Pharmacy Benefit Management services provider

About Abarca Health

Abarca Health provides Pharmacy Benefit Management (PBM) services, focusing on flexible and user-friendly solutions for health plans, employers, and government programs like Medicare and Medicaid. Its main product, the Darwin platform, allows clients to quickly implement and modify benefit designs while ensuring compliance with regulations. Abarca Health manages over $5.3 billion in drug spend and processes 100 million prescription claims annually, offering additional services like home delivery for prescriptions. The company's goal is to deliver exceptional service and innovative solutions in the PBM market.

Aventura, FloridaHeadquarters

2005Year Founded

VENTURE_UNKNOWNCompany Stage

HealthcareIndustries

501-1,000Employees

Benefits

PTO

Parental leave

Work flexibility

Health insurance

Wellness stipend

401k

Tuition reimbursement

Leadership development programs

Risks

Increased competition from Amazon Pharmacy and Mark Cuban's Cost Plus Drug Company.

Growing focus on specialty drugs may require platform adaptation.

Shift towards price transparency could pressure Abarca's pricing models.

Differentiation

Abarca Health's Darwin platform is highly adaptable and user-friendly.

The company offers innovative programs like Triple S en Casa for home delivery.

Abarca Health ensures compliance with ever-changing healthcare regulations.

Upsides

Abarca transitioned two million members to Darwin in 18 months, showing operational efficiency.

Collaboration with Blue Shield of California boosts Abarca's reputation in the PBM sector.

Recognition as a top IT workplace attracts top talent, driving innovation.

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