Patient Access Specialist – Differential Waiver

🔥 3 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $16 - $23 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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👻 Ghost score 0%

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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

• Review and validate insurance eligibility, prior authorization, and medication/procedure referrals • 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 other 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 • Contact third-party payers regarding prior authorization processes • Collaborate with provider offices to clarify documentation and demonstrate medical necessity • Follow up with provider offices regarding ABNs or waivers when medical necessity criteria are not met • Review professional services denials and assist with appeals • Assure required referrals are in place and work on outgoing referrals • 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 cross-functional teams • Assist with data design and management, including reports and presentations

🎯 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 required • Insurance background required • Office equipment and computer proficiency required