Patient Access Specialist

Sanford Health

Patient Access Specialist validating insurance benefits, referrals, and prior authorizations for Sanford Health’s rural healthcare system. Coordinating documentation, payer communications, denials, and medical necessity reviews.

Posted 8/14/2026full-timeRemote • South Dakota • 🇺🇸 United StatesJuniorMid-Level💰 $17 - $27 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in insurance eligibility verification, prior authorization processes, and medical terminology. Proficient in collaborating with healthcare professionals and managing documentation for medical services and referrals.

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 BackgroundUnderstanding of Medical TerminologyVerification of Patient RegistrationCPT Code RetrievalData Design and Management

Soft Skills

Communication with Third-Party PayersCollaboration with Cross-Functional Teams

Tools & Technologies

Case Management ModuleOffice EquipmentComputers

Industry Keywords

Prior AuthorizationMedical NecessityHealthcare ServicesInpatient ServicesReferrals

About the role

Key responsibilities & impact

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 to prioritize requests
Verify patient registration and benefit coverage, including deductibles and out-of-pocket expenses
Research and verify 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
Contact third-party payers to determine the appropriate prior authorization process
Work with provider offices to obtain and clarify documentation demonstrating medical necessity
Guide provider offices on Advanced Beneficiary Notices or waivers when medical necessity criteria are not met
Review professional services denials and work with clinics and third-party payers on appeals
Ensure required referrals are in place and work on outgoing referrals for care outside Sanford Health
Provide minimal telephone interaction with patients regarding provider referrals
Notify insurance companies when patients check in for inpatient services and observation procedures
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 preparing 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
Knowledge of office equipment and computers required

Benefits

Comp & perks

Salary range of $16.50 - $26.50 per hour
Day shift
40 scheduled weekly hours
EEO/AA Employer M/F/Disability/Vet
Disability accommodation support for the online application