Patient Access Specialist - Prior Authorization
Company: Sanford Health
Location: Fargo
Posted on: February 4, 2025
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Job Description:
Careers With Purpose 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. Facility: Remote ND (Fargo) Location: Fargo, ND Address:
Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours:
40.00 Salary Range: $ 16.50 - $ 26.50 Job Summary The Patient
Access Specialist reviews and validates insurance eligibility,
prior authorization and/or referral of medication, procedures,
etc.; determines if insurance meets prior authorization criteria.
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, including testing, procedures,
surgery, Durable Medical Equipment (DME), and medications is
completed and confirmed. Obtains diagnosis(es)/CPT code(s) from
medical chart and/or provider office. Contacts third party payer to
determine appropriate prior authorization process. Works closely
with provider offices to obtain and clarify documentation to
demonstrate medical necessity. If medical necessity criteria are
not met, follows up with provider offices with guidance for
Advanced Beneficiary Notices (ABN) or waivers that releases the
financial burden of scheduled services from the facility to the
patient. Reviews professional services denials; works with clinics
and third party payers on appeal process. Assures all required
referrals are in place; may work on outgoing referrals for care
outside Sanford Health. May have minimal telephonic patient
interaction concerning provider referrals. May notify appropriate
insurance companies when patients have checked in for inpatient
services and procedures requiring observation periods. Documents
work in case management module; provides direction to utilization
management, case management, and nursing regarding what action
needs to be taken. Collaborates with case management, social work,
utilization management, and other cross-functional teams across the
enterprise. Assists with the design and management of data
including the preparation of reports and presentations.
Qualifications 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, insurance background, office equipment and
computers is required. Benefits Sanford Health offers an attractive
benefits package for qualifying full-time and part-time employees.
Depending on eligibility, a variety of benefits include health
insurance, dental insurance, vision insurance, life insurance, a
401(k) retirement plan, work/life balance benefits, and a generous
time off package to maintain a healthy home-work balance. For more
information about Total Rewards, visit . 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 1- or send an email to .
Sanford Health has a Drug Free Workplace Policy. An accepted offer
will require a drug screen and pre-employment background screening
as a condition of employment. Req Number: R- Job Function: Revenue
Cycle Featured: No
Keywords: Sanford Health, Fargo , Patient Access Specialist - Prior Authorization, Other , Fargo, North Dakota
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