Patient Access Specialist – Differential Waiver

Sanford Health

. Serve as a float resource for various departments and specialties .

Posted 10/13/2026full-timeRemote • Wisconsin • United StatesJuniorMid-Level💰 $17 - $27 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in insurance eligibility verification, prior authorization processes, and medical terminology, while effectively collaborating with healthcare professionals and third-party payers. Proficient in documentation management and data analysis to support case management and utilization management functions.

Highest-signal resume keywords

Insurance Eligibility VerificationPrior Authorization ProcessesMedical TerminologyDocumentation ManagementCollaboration with Healthcare Professionals

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance BackgroundCPT CodingPatient Registration VerificationBenefit Coverage AnalysisMedical Necessity Documentation

Soft Skills

CommunicationCollaborationProblem-Solving

Tools & Technologies

Case Management ModuleOffice EquipmentData Management Software

Industry Keywords

HealthcareHospital SettingClinic SettingThird-Party PayersUtilization Management

About the role

Key responsibilities & impact

Serve as a float resource for various departments and specialties
Review and validate insurance eligibility, prior authorization, and referrals for medications, procedures, and other services
Collect documentation and communicate with third-party payers, healthcare professionals, and customers
Verify patient registration and benefit coverage, including deductibles and out-of-pocket expenses
Research covered benefits for ordered tests, procedures, and 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
Work with provider offices to obtain documentation demonstrating medical necessity
Follow up with provider offices regarding ABNs or waivers when medical necessity criteria are not met
Review professional services denials and work with clinics and third-party payers on appeals
Assure required referrals are in place, including outgoing referrals outside Sanford Health
Notify insurance companies about inpatient services and procedures requiring observation periods
Document work in the case management module and provide direction to utilization management, case management, and nursing
Collaborate with case management, social work, utilization management, and other cross-functional teams
Assist with data design and management, including preparation of reports and presentations

Requirements

What you’ll need

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
High school diploma or equivalent preferred
Post-secondary education helpful