Billing Associate at Abarca Health

Sioux Falls, South Dakota, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PharmacyIndustries

Requirements

Associate's Technical degree or 1 to 2 years of related experience
1-3 years of related experience
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
Ability to work specified hours: 9:30am-6:00pm, every 3rd weekend/holiday; 80hrs/2wks
Commitment to Avera’s mission, vision, core values, and social principles
Uphold Avera’s 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

Verify, submit, and adjudicate patient billing information
Submit necessary claim forms and reconcile accounts receivable remittances appropriately
Document tracking information to customer's accounts
Verify and correct billing input for claim processing
Reconcile Point of Sale cash flow
Respond to external and internal customers' concerns regarding accounts in a timely and accurate manner
Investigate reports and correct information for complete accuracy; provide corrections and documentation to patients and appropriate departments
Investigate and report on current reimbursement developments on third party remittances; maintain compliance with coding/billing requirements
Direct the preparation, completion, and filing of third party payor insurance reimbursement claims (electronic and paper formats)
Process explanation of Medicare Benefits for supplemental insurances
Verify bill accuracy and review to initiate appeal information when appropriate; collaborate with other departments for follow-up and timely resolution
Comprehend/interpret organization policies and procedures; maintain appropriate records for compliance and audit purposes
Correspond with other departments for necessary billing information
Reconcile cash management and coordinate daily deposits for all applicable areas
Provide excellent customer service to external and internal customers

Skills

Medical Billing

Claim Adjudication

Accounts Receivable

Insurance Claims

Customer Service

Medicare Benefits

Billing Compliance

Electronic Claims

Paper Claims

Appeals Processing

Point of Sale Reconciliation

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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