Admissions Specialist I at Abarca Health

Sioux Falls, South Dakota, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, HospitalIndustries

Requirements

Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
Flexibility to work rotating days/evenings/nights/weekends, primarily Monday-Friday 8:00 AM - 4:30 PM with occasional weekends
Ability to perform essential job functions satisfactorily, with reasonable accommodations for disabilities

Responsibilities

Register patients in a timely and accurate manner by entering demographic, insurance, physician, and other defined information while following established registration standards
Perform all necessary procedures to create accounts/medical record numbers and verify insurance coverage and limitations
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 plan benefits at time of service or pre-calling, and identify collection goals based on deposit matrix/patient estimator tools
Request and accept deposits towards deductibles and/or coinsurance from patients and post payments correctly to the payment processing system
Maintain positive customer relations with 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
Complete insurance verification, pre-certification/authorization for assigned accounts
Interact with patients in Patient Care units to complete registration, obtaining consents, informing about telephone consumer protection act, insurance information, referring physicians, and CMS required documentation (e.g., IMMs, MOON, OBVs)
Check for medical necessity by confirming CPOM order and status of care at time of admission for direct admits
Collect patient co-payments, deductibles, and out-of-pocket expenses and communicate this to the patient

Skills

Patient Registration

Insurance Verification

Bedside Registration

Patient Demographics Entry

Co-payment Collection

Pre-certification

Authorization

Point of Care Collection

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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