Patient Access Specialist

This is a fully remote position, open to applicants in North Dakota, +2 more states.

📋 Description

• Assess and confirm insurance eligibility, prior authorization, and referrals for medications or procedures.

• Evaluate if insurance complies with prior authorization standards.

• Gather documentation and liaise with third-party payers, healthcare providers, and clients to prioritize requests.

• Verify patient registration and benefit coverage, including deductibles and out-of-pocket costs.

• Investigate and validate covered benefits for tests, procedures, and additional services.

• Complete and verify prior authorizations for medical services, testing, procedures, surgeries, DME, and medications.

• Extract diagnoses and CPT codes from medical charts or provider offices.

• Reach out to third-party payers to identify the correct prior authorization procedures.

• Collaborate with provider offices to obtain and clarify documentation that proves medical necessity.

• Advise provider offices on Advanced Beneficiary Notices or waivers when medical necessity criteria are not fulfilled.

• Analyze professional service denials and assist with appeals in partnership with clinics and third-party payers.

• Ensure necessary referrals are established and manage outgoing referrals for care outside Sanford Health.

• Conduct minimal phone interactions with patients regarding provider referrals.

• Inform insurance companies when patients check in for inpatient services and procedures that require observation periods.

• Record activities in the case management module.

• Provide guidance to utilization management, case management, and nursing about necessary actions.

• Collaborate with case management, social work, utilization management, and other interdisciplinary teams.

• Support data design and management, including the preparation of reports and presentations.

⛳️ Requirements

• Preferred high school diploma or equivalent.

• Additional post-secondary education is beneficial.

• A minimum of two years of experience in a hospital or clinic environment is required.

• Proficiency in medical terminology is essential.

• A background in insurance is necessary.

• Familiarity with office equipment and computer systems is required.

🏝️ Benefits

• Full-time employment.

• Day shift hours.

• 32 scheduled hours each week.

• EEO/AA Employer M/F/Disability/Vet.

• Disability accommodations are available for the online application.