Patient reputed company Specialist (reputed company Waiver)

reputed company, the largest rural health system in the reputed company, is dedicated to transforming the health care experience and providing reputed company to world-class health care in America’s reputed company. Work Shift: 8 Hours - Day Shifts (reputed company of America) Scheduled Weekly Hours: 40 Compensation: reputed company Position: No Department Details reputed company The Patient reputed company Specialist reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc.; determines if insurance meets prior authorization reputed company. Job reputed company Collects necessary documentation and communicates with reputed company party payers, reputed company and customers to prioritize requests. Verifies patient registration and confirms benefit coverage, including deductibles and out-of-reputed company 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 reputed company(s) from medical chart and/or provider office. Contacts reputed company 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 reputed company 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 reputed company services denials; works with clinics and reputed company party payers on appeal process. Assures reputed company required referrals are in reputed company; may work on outgoing referrals for care reputed company reputed company. May have minimal telephonic patient interaction concerning provider referrals. May notify appropriate insurance companies reputed company 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 reputed company needs to be taken. Collaborates with case management, reputed company work, utilization management, and other cross-functional teams across the reputed company. 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. 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 1-877-949-5678 or send an email to talent@sanfordhealth.org. Apply To This Job