Patient Financial Navigator at Abarca Health

Sioux Center, Iowa, United States

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Not SpecifiedCompensation

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

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

High school diploma or GED
One to three months related experience and/or training, or equivalent combination of education and experience
One or two year college level education preferred
One to three years prior hospital-based Business Office operation experience preferred
Bi-lingual experience preferred but not required

Responsibilities

Make financial arrangements for patients in a variety of financial and insurance positions
Collect deposits prior to service when applicable
Assist in obtaining financing for services
Demonstrate a basic understanding of government programs and screen and refer patients when applicable
Provide charity applications as requested or deemed appropriate for the patient
Ensure insurance eligibility, benefit verification, and patient estimates
Understand and interpret patient liability and benefits for all payer types including copays, co-insurance, and out-of-pocket responsibilities
Provide patients and families with information on their financial responsibility
Verify patient demographics, insurance coverage, mnemonics, and benefits prior to scheduled services
Work with Patient Access team to resolve discrepancies or missing information
Confirm medical necessity, prior authorizations, eligibility, and physician orders are in place
Ensure accurate pre-registration and timely communication of information with clinical and billing teams
Screen (pre-call) scheduled non-urgent patients (in and outpatient) prior to service, collect minimum payment prior to surgery, and assure plan for financial coverage is in place before service is performed
Educate patients on their rights and responsibilities regarding healthcare costs
Provide clear personalized cost estimates of charges and out-of-pocket costs for procedures, treatments, or services
Identify potential coverage issues and work to resolve issues before service
Review with patients prior to or at time of care to explain estimated costs, insurance coverage, and potential out-of-pocket expenses
Screen self-pay patients for potential payer coverage
Assist uninsured or underinsured patients with insurance enrollment or alternative coverage options (e.g., Medicaid, Marketplace plans)
Educate patients on available financial assistance, payment plans, and charity care

Skills

Key technologies and capabilities for this role

insurance eligibility verificationbenefit verificationpatient financial counselinggovernment programs knowledgecharity applicationspatient estimatesfinancial arrangements

Questions & Answers

Common questions about this position

What is the location for this Patient Financial Navigator position?

The position is located in Sioux Center, IA, with day shift hours Monday through Friday.

What education and experience are required for this role?

A high school diploma or GED is required, with one to three months of related experience or training preferred. One or two years of college-level education and one to three years of prior hospital-based Business Office experience are preferred, along with bilingual skills.

What does the company culture at Sioux Center Health feel like?

Sioux Center Health nurtures an exceptional culture driven by a strong mission, great people, faith and healing, and a caring Christian environment where talents and passions are appreciated.

What are the salary and benefits for this position?

This information is not specified in the job description.

What makes a strong candidate for the Patient Financial Navigator role?

Strong candidates will have hospital-based Business Office experience, college-level education, and bilingual skills, along with a basic understanding of government programs, insurance eligibility, and financial counseling.

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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