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Sanford HealthPosted 10/21/2026full-timeRemote • Minnesota • United StatesJuniorMid-Level💰 $17 - $27 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance eligibility verification, prior authorization processes, and medical terminology. Capable of collaborating with healthcare professionals and managing documentation to ensure compliance and facilitate patient care.
Highest-signal resume keywords
Insurance Eligibility VerificationPrior Authorization ProcessesMedical TerminologyDocumentation ManagementCollaboration with Healthcare Professionals
About the role
Key responsibilities & impact- Review and validate insurance eligibility, prior authorization, and medication/procedure referrals
- Determine whether insurance meets prior authorization criteria
- Collect documentation and communicate with third-party payers, healthcare professionals, and customers
- Verify patient registration and confirm benefit coverage, deductibles, and out-of-pocket expenses
- Research and verify covered benefits for tests, procedures, and other services
- Complete and confirm prior authorization for medical services, testing, procedures, surgery, DME, and medications
- Obtain diagnosis and CPT codes from medical charts or provider offices
- Coordinate with payers and provider offices to clarify documentation and demonstrate medical necessity
- Follow up on unmet medical necessity criteria and provide guidance for ABNs or waivers
- Review professional services denials and support appeals with clinics and payers
- Assure required referrals are in place and work on outgoing referrals
- Notify insurers regarding inpatient services and procedures requiring observation periods
- Document work in the case management module
- Provide direction to utilization management, case management, and nursing
- Collaborate with case management, social work, utilization management, and cross-functional teams
- Assist with data design and management, reports, and presentations
Requirements
What you’ll need- 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 required
- Insurance background required
- Experience with office equipment and computers required
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prior AuthorizationCPT CodingMedical Chart ReviewBenefit VerificationDocumentation in Case Management Module
Soft Skills
CommunicationCollaborationProblem-Solving
Tools & Technologies
Office EquipmentComputers
Industry Keywords
HealthcareInsuranceUtilization ManagementCase ManagementPatient Registration