Abarca Health

Patient Financial Services Representative

Remote

Not SpecifiedCompensation
Entry Level & New Grad, Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Mental Health, BiotechnologyIndustries

Requirements

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.

Responsibilities

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.

Skills

Patient Financial Services
Customer Service
Healthcare
Billing
Insurance Verification
Payment Processing
Communication

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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