Pharmacy Patient Specialist - Bone Health | Inpatient at Abarca Health

Sioux Falls, South Dakota, United States

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$42,120 – $60,840Compensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, PharmacyIndustries

Requirements

High School or GED Equivalent or one to three months related experience and/or training; or equivalent combination of education and experience
Registered Pharmacy Technician - Board of Pharmacy within 30 Days
Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board (PTCB) within 90 Days or Certified Pharmacy Technician (CPhT) - National Healthcareer Association (NHA) within 90 Days
1-3 years experience as a certified pharmacy technician
Working knowledge of insurance, Medicare, and basic accounting principles
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
Ability to deal with phone conversations, correspondence, or direct contact with people about billing issues

Responsibilities

Works proactively with pharmacy patients to provide comprehensive financial planning and financial advocacy
Responsible for prescription insurance verification, prior authorizations, and compassionate care medication programs
Works to reduce access and financial barriers to medications for patients
Provides superior customer service; facilitates third party and patient billing for pharmacy patients
Secures pharmacy patient accounts to ensure payment of medications; provides problem solving for patients and internal customers
Coordinates workflow with other members of the healthcare team to ensure a productive and efficient environment
Understands the process of insurance verification and online prescription adjudication
Investigates patient insurance benefits and other supplemental payer information to maximize prescription medication funding and minimize out of pocket expenses
Investigates alternate funding from non-profit foundations or manufacturer sponsored compassionate care programs
Initiates and monitors prior authorizations
Maintains communication with health care providers, pharmacy benefit managers, and pharmacy patients to ensure timely delivery of medications
Performs clerical/billing functions associated with the medication distribution system
Accurately packages and labels drug products and makes routine and special deliveries of medications
Prepares outpatient prescriptions for distribution
Assists with the collection and maintenance of records as needed by the Pharmacy department, Joint Commission accreditation, OSHA guidelines, and other accreditation as may be required by law, practice standards, or departmental policy
Works closely with pharmacy staff to assure compliance with all applicable accreditation standards and State and Federal requirements and regulations
Participates in continuous quality improvement activities which comprises at least 10% of duties and promotes patient safety

Skills

Key technologies and capabilities for this role

insurance verificationprior authorizationsprescription adjudicationpatient billingfinancial advocacyMedicarepatient benefits investigationcompassionate care programspharmacy benefit managerscustomer serviceaccounting principles

Questions & Answers

Common questions about this position

What is the pay range for the Pharmacy Patient Specialist role?

The pay range is $20.25 - $29.25, with actual pay rate dependent upon experience.

Is there a sign-on bonus available?

The position may be eligible for a $4,000 sign-on bonus.

Where is this position located and what is the work shift?

The position is located at Avera McKennan Hospital with a day shift schedule in the United States.

What key skills are required for this role?

Requires working knowledge of insurance, Medicare, and basic accounting principles, along with skills in insurance verification, prior authorizations, patient billing, and customer service.

What is the team environment like at Avera?

You will be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for patients, working where you matter.

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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