Patient Access Specialist

This is a fully remote position, open to applicants in South Dakota.

📋 Description

• Assess and confirm insurance eligibility, prior authorizations, and referrals related to medications, procedures, and various services.

• Gather necessary documentation and liaise with third-party payers, healthcare professionals, and customers to prioritize requests effectively.

• Verify patient registration and benefit coverage, including details about deductibles and out-of-pocket expenses.

• Investigate and confirm covered benefits for tests, procedures, and services that have been ordered.

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

• Retrieve diagnosis and CPT codes from medical records or provider offices.

• Reach out to third-party payers to ascertain the correct prior authorization process.

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

• Provide guidance to provider offices on Advanced Beneficiary Notices or waivers when medical necessity criteria are unmet.

• Analyze professional services denials and collaborate with clinics and third-party payers on appeals.

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

• Maintain minimal telephone communication with patients regarding provider referrals.

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

• Document activities in the case management module and offer direction to utilization management, case management, and nursing teams.

• Collaborate with case management, social work, utilization management, and other cross-functional teams.

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

⛳️ Requirements

• High school diploma or equivalent is preferred; post-secondary education is advantageous.

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

• A solid understanding of medical terminology is mandatory.

• A background in insurance is essential.

• Proficiency with office equipment and computer systems is required.

🏝️ Benefits

• Salary range of $16.50 - $26.50 per hour.

• Day shift schedule.

• 40 scheduled hours per week.

• EEO/AA Employer M/F/Disability/Vet.

• Support for disability accommodation during the online application process.