Billing Associate at Abarca Health

Sioux Falls, South Dakota, United States

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$37,976 – $49,400Compensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
Associate's Technical degree or 1 to 2 years of related experience
1-3 years of related experience
Commitment to Avera’s mission, vision, core values, and social principles
Uphold standards of Communication, Attitude, Responsiveness, and Engagement (CARE)
Maintain confidentiality
Work effectively in a team environment
Comply with safety principles, laws, regulations, and standards (e.g., CMS, The Joint Commission, DHHS, OSHA)

Responsibilities

Verifies, submits, and adjudicates patient billing information
Submits necessary claim forms and reconciles accounts receivable remittances appropriately
Documents tracking information to customer's accounts
Verifies and corrects billing input for claim processing
Reconciles Point of Sale cash flow
Responds to external and internal customers' concerns regarding accounts in a timely and accurate manner
Investigates reports and corrects information necessary for complete accuracy; provides corrections and documentation to patients and appropriate departments
Investigates and reports on current reimbursement developments on third party remittances
Maintains compliance with coding/billing requirements
Directs the preparation, completion, and filing of third party payor insurance reimbursement claims (electronic and paper formats)
Processes explanation of Medicare Benefits for supplemental insurances
Verifies bill accuracy and reviews to initiate appeal information when appropriate
Collaborates with other departments for follow-up and timely resolution
Comprehends/interprets organization policies and procedures; maintains appropriate records for compliance and audit purposes
Corresponds with other departments for necessary billing information
Reconciles cash management and coordinates daily deposits for all applicable areas
Provides excellent customer service to external and internal customers

Skills

billing verification

claims submission

accounts receivable

insurance adjudication

cash reconciliation

Medicare EOB

appeals processing

compliance coding

customer service

third-party remittances

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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