Patient Access Specialist – Differential Waiver, Prior Authorization

🔥 2 minutes ago

🌾 North Dakota, Minnesota, +1 more states – Remote

🌾 North Dakota – Remote ❄️ Minnesota – Remote 🗿 South Dakota – Remote

💵 $16 - $26 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• Reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc. • Collects necessary documentation and communicates with third party payers, healthcare professionals and customers to prioritize requests. • Verifies patient registration and confirms benefit coverage, including deductibles and out-of-pocket expenses; researches and verifies covered benefits for ordered tests, procedures, and other services. • Responsible for assuring that prior authorization for medical services is completed and confirmed. • Obtains diagnosis(es)/CPT code(s) from medical chart and/or provider office. • Contacts third party payer to determine appropriate prior authorization process. • Works closely with provider offices to obtain and clarify documentation to demonstrate medical necessity. • Reviews professional services denials; works with clinics and third party payers on appeal process.

🎯 Requirements

• High school diploma or equivalent preferred; post-secondary education helpful. • Minimum of two years of experience in a hospital or clinic setting required. • Understanding of medical terminology, insurance background, office equipment and computers is required.

🏖️ Benefits

• Opportunity to work remote