Benefits Configuration Analyst
SmithRxFull Time
Mid-level (3 to 4 years)
Candidates should have at least 3 years of experience in insurance benefits, billing procedures, and prior authorization processes, with a preference for SMI/BH experience. Experience using commercial insurance payor portals is required, and Medicare and Medicaid experience is highly preferred. The role also requires experience in an externally facing role, ideally working directly with patients, and comfort with phone-based work. Strong communication skills to translate complex payer or process issues into clear action steps are essential, along with high emotional intelligence (EQ) and a service orientation. Adaptability, resilience, and comfort in fast-moving, ambiguous environments are also key requirements.
The Patient Financial Services Representative will manage the member-facing phone line, providing compassionate, timely, and solutions-oriented support. They will perform Verifications of Benefits (VOBs) to ensure members can access care and collaborate with the member growth team to streamline onboarding. Responsibilities include overseeing and supporting the Prior Authorization Process, ensuring timely submission of requests, and assisting with member billing, collections, and payment posting in compliance with policies and regulations. The role involves bringing a bias to action, high EQ, detail-oriented execution, and the ability to calmly navigate change and challenges.
Pharmacy Benefit Management services provider
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.