Scheduling Specialist - Ortho at Abarca Health

Sioux Falls, South Dakota, United States

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$37,960 – $49,400Compensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, OrthopedicsIndustries

Requirements

Knowledge of medical terminology
High School or GED Equivalent (preferred)
Associate's in medical secretarial school (preferred)
1-3 years experience as a scheduler, biller, or in a medical office (preferred)
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
Commitment to Avera’s mission, vision, core values, and social principles
Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE)
Maintain confidentiality
Work effectively in a team environment
Comply with safety principles, laws, regulations, and standards (e.g., CMS, The Joint Commission, DHHS, OSHA)

Responsibilities

Complete prior and pre-authorizations for patients' insurance companies
Work appeals for insurance coverage
Verify benefits
Make referrals and schedule pre-operative physicals
Review surgery information with patients
Schedule, maintain, and disseminate an accurate surgery schedule
Acquire, retain, and organize documentation
Provide clerical services for the department as indicated
Obtain information (including physician orders) from physician offices for scheduling tests, procedures, and admissions in an accurate, timely, and sequential manner
Facilitate coordinating a plan of care for patients with various departments throughout the hospital and clinics
Work with equipment vendors for surgical equipment needs
Coordinate care between facilities for utilization of telemedicine to ensure continuity of care if applicable
Communicate information to physicians, staff, families, etc., in an appropriate and professional manner when directed
Assist with the collection and maintenance of records as needed by Performance Improvement, Joint Commission accreditation, CARF certification, OSHA guidelines, or as required by law
Coordinate scheduling of specialized equipment based on procedures
Maintain physician calendar, procedure schedule, and all coordinating orders for procedures

Skills

Insurance Verification

Prior Authorizations

Pre-Authorizations

Scheduling

Patient Referrals

Surgery Scheduling

Benefits Verification

Appeals Processing

Telemedicine Coordination

Clerical Services

Record Maintenance

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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