Patient Advocate | PRN at Abarca Health

Sioux Falls, South Dakota, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Part TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Maintain knowledge base of community agencies and resources to facilitate appropriate referrals, including thorough understanding of eligibility requirements and current laws governing government programs
Communicate effectively with patients, families, case managers, and providers to assess care plans and corresponding coverage needs
Work in a compassionate and tactful manner to help facilitate access to and provide continuity of care
Collaborate with other members of the care teams, insurers, financial, and administrative personnel

Responsibilities

Screen patients to determine potential for program assistance, complete applications with patients and families, and follow up after discharge regarding applications
Obtain detailed patient insurance benefit information for all aspects of cancer care, including outpatient services and prescription drugs; verify coverage and benefits; acquire necessary referrals and authorizations
Identify self-pay patients and evaluate coverage opportunities; assist with completion of all needed applications for coverage, including drug assistance; provide accurate cost estimate details to patients prior to appointments
Discuss benefits and financial concerns with patients and/or family members during initial referral and continuation of care; identify and communicate financial information to team members, patients, and families, emphasizing potential out-of-pocket liability; assist with insurance, coverage, and financial questions; document in patient record as appropriate
Obtain all necessary insurance authorizations; acquire clinical information from medical records; communicate with care team and pharmacy staff to ensure treatments meet medical necessity; draft medical necessity authorization request letters; manage routine and complex authorizations; coordinate level II appeals with oversight from medical staff
Address insurance coverage gaps via alternative funding options, including copay assistance, compassionate use drugs, Avera Patient Assistance; assist with work-related documentation (e.g., FMLA, short-term/long-term disability, work letters)
Maintain tracking mechanisms for status of authorization requests, referrals, and drug assistance; regularly assess updated insurance data, authorizations, and preferred providers; track free drug assistance to ensure ongoing coverage
Facilitate resolution of patient billing issues, including appealing denied claims; collaborate with patients, insurance, and business office
Work as a member of a team of Patient Advocates to assist others

Skills

Insurance Verification

Benefits Screening

Referrals

Authorizations

Patient Billing

Financial Assistance

Drug Assistance Programs

Cost Estimates

Coverage Applications

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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