Patient Access Specialist
4 days ago
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Work Shift:
Day (United States of America)Scheduled Weekly Hours:
40Salary Range: $ $26.50Union Position:
NoDepartment Details
Summary
The Patient Access Specialist reviews and validates insurance eligibility and prior authorization for long term care services referred (ex. home health, hospice, skilled nursing, assisted living, senior living).Job Description
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 and Durable Medical Equipment (DME) is completed and confirmed. Contacts third party payer to determine appropriate prior authorization process as necessary. Works closely with referral sources to obtain and clarify documentation to demonstrate medical necessity. If medical necessity criteria are not met, follows up with referral sources. Reviews medical services denials; works with interdisciplinary team and third party payers on appeal process.
Assures all required referrals are in place; may work on referrals for care outside the service area. May have minimal telephonic patient interaction concerning provider referrals. Documents work in EMR to provide direction to interdisciplinary team regarding what action needs to be taken. Collaborates with case management, social work, utilization management, and other interdisciplinary team members regarding ongoing authorization needs.
Qualifications
High school diploma or equivalent preferred. Post-secondary education helpful.Minimum of two years of experience in a medical setting required. Understanding of medical terminology, insurance background, office equipment and computers is required.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application, please call or send an email to
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