Revenue Integrity Analyst at Abarca Health

Sioux Falls, South Dakota, United States

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$53,040 – $79,560Compensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Associate's in Healthcare Administration, Finance, Business Analytics, or related field and/or 2-3 years of experience in healthcare revenue cycle analytics, charge auditing, or payment integrity
Two to three years experience in healthcare revenue cycle analytics, charge auditing, or payment integrity
Knowledge of healthcare billing, denial management, and/or payer reimbursement methodologies
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds

Responsibilities

Design, maintain, and enhance dashboards and scorecards for denials, write-offs, payer performance, and charge activity. Analyze trends and translate complex data into actionable insights for stakeholders
Conduct audits and Revenue Guardian checks to validate charge accuracy and completeness. Perform payer-specific audits and monitor ED Discharge and Charge Tracker Reports
Monitor and resolve Discharged Not Billed (DNB) accounts to ensure timely claim submission
Investigate denials and underpayments, identify root causes, and recommend process improvements
Manage appeals for underpaid claims, track outcomes, and report on recovery efforts and payment trends
Review high-dollar write-offs for appropriateness and escalate discrepancies as needed
Oversee Post-Service Single Case Agreements (SCAs) to ensure reimbursement accuracy and adherence to contract terms
Partner with clinical, operational, and payer relations teams to resolve discrepancies and improve documentation
Participate in audits, strategic initiatives, and projects aimed at financial optimization and revenue integrity

Skills

Key technologies and capabilities for this role

Revenue Cycle ManagementCharge AuditingData AnalyticsDashboardsSQLExcelDenials ManagementAppeals ManagementPayer ContractsBilling ComplianceHB BillingPB BillingRoot Cause Analysis

Questions & Answers

Common questions about this position

What is the pay range for the Revenue Integrity Analyst position?

The pay range is $25.50 - $38.25, with actual pay rate dependent upon experience.

Is this a remote position or does it require on-site work?

This information is not specified in the job description.

What education or experience is required for this role?

An Associate's degree in Healthcare Administration, Finance, Business Analytics, or related field is required.

What is the company culture like at Avera?

It's a compassionate multidisciplinary team environment focused on Moving Health Forward for patients, where you belong and your work matters.

What skills make a strong candidate for this position?

Strong candidates will have expertise in analytics, charge auditing, data analysis for trends, and collaboration with clinical, billing, coding, IT, and payer teams.

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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