Enrollment Coordinator I at Abarca Health

Sioux Falls, South Dakota, United States

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$49,400 – $66,000Compensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Associate's from a two-year college or technical school or an equivalent combination of education and experience
1-3 years advanced medical or administrative experience and/or training
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
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

Coordinate the initial enrollment and re-enrollment process for providers, including collecting and submitting necessary documentation and applications
Provide support and guidance on enrollment standards, PECOS administration, and ongoing revalidation processes
Maintain current knowledge of applicable state and federal regulations regarding enrollment, and adjust procedures accordingly
Manage enrollment-related claim holds in accordance with Avera CBO policies and payer requirements
Perform accurate data entry and maintain enrollment records within the credentialing system and internal databases
Maintain and update records in the NPI registry and furnish current W-9s as needed
Ensure proper EFT setup for all newly enrolled hospitals or group locations
Serve as a resource to the credentialing team, assisting with government payer requirements
Maintain accurate records of banking relationships for all enrolled entities

Skills

Enrollment Coordination

Credentialing

PECOS

NPI Registry

EFT Setup

Data Entry

Regulatory Compliance

Claims 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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