Patient Access Specialist – Differential Waiver

🔥 16 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $16 - $26 / hour

⏰ Full 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

• Serve as a float resource for various departments and specialties • Review and validate insurance eligibility, prior authorization, and referrals for medications, procedures, and other services • Collect documentation and communicate with third-party payers, healthcare professionals, and customers • Verify patient registration and benefit coverage, including deductibles and out-of-pocket expenses • Research covered benefits for ordered tests, procedures, and services • Complete and confirm prior authorization for medical services, testing, procedures, surgery, DME, and medications • Obtain diagnosis and CPT codes from medical charts or provider offices • Work with provider offices to obtain documentation demonstrating medical necessity • Follow up with provider offices regarding ABNs or waivers when medical necessity criteria are not met • Review professional services denials and work with clinics and third-party payers on appeals • Assure required referrals are in place, including outgoing referrals outside Sanford Health • Notify insurance companies about inpatient services and procedures requiring observation periods • Document work in the case management module and provide direction to utilization management, case management, and nursing • Collaborate with case management, social work, utilization management, and other cross-functional teams • Assist with data design and management, including preparation of reports and presentations

🎯 Requirements

• Minimum of two years of experience in a hospital or clinic setting required • Understanding of medical terminology required • Insurance background required • Experience with office equipment and computers required • High school diploma or equivalent preferred • Post-secondary education helpful