Patient Access Specialist - Specialty Pharmacy

Fargo, ND
Commute links off-site

Job Details

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: Sanford Broadway Clinic
Location: Fargo, ND
Address: 737 Broadway N, Fargo, ND 58102, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $16.50 - $26.50

Department Details

Sanford Specialty Pharmacy is a fast growing department supporting patients across the full footprint of Sanford Health. Pharmacy operations are located in Fargo, ND. Our primary goal is to provide excellent customer service and help patients receive Specialty medications faster and maintain compliance on therapy.

Sanford Specialty Pharmacy is open Monday through Friday 8am-5pm, no weekends, no nights and closed on major holidays. Primary patient interactions are completed over the phone.

Sanford Specialty pharmacy is looking for a new team member who has great customer service, high attention to detail, adaptable to ever growing department needs, can multi-task with multiple systems, and ability to work well with pharmacy team staff and clinic staff.

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 https://sanfordcareers.com/benefits .

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 1-877-673-0854 or send an email to talent@sanfordhealth.org .

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-0223657
Job Function: Revenue Cycle
Featured: No

Equal Employment Opportunity

Sanford and its affiliate brands have consistently operated under the principle of equal treatment for all persons; all qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, gender, gender identity, age, sexual orientation, genetic information, marital status, disability, military or veteran status, in regard to public assistance or any other basis prohibited by applicable federal, state or local law.

SAFE: Sanford Accountability for Excellence

As caregivers, we commit to the safety of those we serve and each other by creating a psychologically safe environment where everyone is included and safe to learn, contribute and raise concerns without fear of negative consequences. When people come to us, they rely on us to keep them safe from harm, do all we can to heal them, and treat them with empathy and compassion – all while embracing our connection to each other. Safety is part of our culture and defines the care we provide, and how we deliver on our universal commitment to a higher level of service and exceptional care.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call (877) 673-0854 or send an email to hrhelp@sanfordhealth.org.

In compliance with federal law requiring employers to verify new employees' U.S. employment eligibility, Sanford participates in E-Verify. To learn more about your right to work: English Version or Spanish Version.

Important Notice

There has been a recent increase in recruitment scams. Protect yourself by learning common indications of a fake job scam. Read More.

If you have questions about the legitimacy of an employment offer from Sanford Health, contact hrhelp@sanfordhealth.org.