Sanford Health

Call Center Representative

• Providing telehealth services involving all ages of patients
• Telephone triage, health information and education, and physician referrals
• Documenting health information accurately

RN Call Center

Director

• Provides temporary nursing facility leadership and support
• Monitors the operations of the nursing staff and ensures compliance with regulations
• Schedules staff and conducts employee performance reviews
• Maintains communication and addresses the rapidly changing healthcare environment

Interim Director of Nursing, RN – Long Term Care

IT Support

• Responsible for following policies and procedures set within the pharmacy department to ensure that Members obtain appropriate medications in a timely, cost-effective, and efficient manner.
• Requires use of and proficiency in multiple computer programs.
• Handle calls from Members, pharmacies, and providers concerning pharmacy issues such as coverage, prior authorization, step therapy, networks, and overrides, and denial rationale.
• Review incoming prior authorization request and contact provider's office, pharmacies, prior authorization department, or Member to clarify the intent of the prior authorization and identify any potential missing information.
• Enter prior authorizations and formulary exception requests into referral form.
• Review Plan policy to determine which requests need to be sent on the clinical pharmacist team for review.
• Complete initial and benefit denial letters.
• Serve as a liaison with the pharmacy benefit manager (PBM) in regards to pharmaceutical questions or issues that arise.
• Serve as a resource for other departments within the health plan.
• Meet and maintain all benchmark stats (prior authorizations, medical claims reviews, phone, approval, denial letters and CRM volume) while holding this position.

Pharmacy Benefit Technician

Product Manager

• Leads the end-to-end product lifecycle, from concept and feasibility through development, launch, and performance evaluation.
• Collaborates with leadership, Performance Excellence, and cross-functional teams to ensure product feasibility.
• Develops and manages comprehensive product plans, including cost-benefit analyses, budgets, schedules, and work plans.
• Coordinates and leads multidisciplinary teams to assess market opportunities, determine financial viability, and evaluate sales potential.
• Maintains a strong understanding of marketing strategies including mobile applications, social media, and SEO/SEM.
• Participates in and leads cross-functional initiatives that support Product Development goals.
• Evaluates and integrates data to inform lifecycle decisions and ensure continuous improvement.
• Develops competitive intelligence tools to assess Sanford Health Plan and Sanford Health System product positioning in the market.
• Integrates multiple complex business cases into a cohesive product portfolio strategy.
• Leads stakeholder engagement throughout the product development lifecycle.

Health Plan Product Manager – Medicare

Medical Billing and Coding

• Review medical documentation and assign appropriate codes (ICD-10, HCPCS, CPT).
• Ensure compliance with coding standards, regulations, and company procedures.
• Work independently and effectively communicate with medical professionals.
• Understand Medicare and Commercial Carrier workflows related to daily coding and denial review.
• Participate in coding team meetings and serve as a subject matter expert.

Coder, Provider Practice

Clinical Research

• Collaborate, consult and provide technical assistance to team members, and analyze research data.
• Assist researchers/scientists with writing grant proposals in the areas of randomization, blinding, power/sample size, study design and statistical methods.
• Knowledge of cross-sectional, case-control, cohort and randomized clinical trial study design required, along with a working knowledge of the following statistical principles; general linear mixed models, generalized linear models, longitudinal analysis, general estimating equations, generalized additive models, survival analysis (Kaplan-Meier, Cox PH regression, accelerated failure time models), survey research methods, analysis of surveys, analysis of observational data, propensity score analysis, weighted and un-weighted analysis of field studies.
• Knowledge the controls for confounding variables found in heterogeneous human populations such as age, race, gender, socioeconomic status, smoking, diet, etc.
• Interpret complex interactions and nonlinearities in data.
• Draw conclusions from the analyses and communicate results with researchers/scientists both orally and in writing.
• Prepare proof-quality figures, tables, statistical methods and results to summarize analyses for journal publications.
• Interact and consult with researchers/scientists to ensure proper use of statistical methodology and interpretation of results.
• Demonstrate the ability to provide complete and accurate information to researchers/scientists.
• Occasional local travel between sites may be required.

Biostatistician – Academic Research

Administration

• Responsible for the preparation of proposals, grant applications and contracts
• Assists project directors and principal investigators with grant applications
• Drafts grant related documents including consortium agreements
• Prepares and/or reviews budgets and justifications
• Reviews and completes grant cover sheets and checklists to ascertain completeness of application
• Approves, submits and tracks applications
• Maintains grant submission sites, central grant and contract file, grant management software data, and researchers' bio-sketches
• May assist grant project teams with the overall project management, reports to funding agencies, time management in meeting project goals and maintaining grant and contract files for audit purposes
• Responsible for coordinating with finance staff to ensure proper management of grant and contract financials.

Grants Administrator

Customer Support

• Provide effective and efficient handling of phone calls from or to Sanford Health members, providers, and colleagues ensuring a positive experience for all members.
• Quickly assess the level of complexity of cases and provide resolution or facilitate escalation of phone call inquiries.
• Provides positive, consistent customer experiences by striving for excellence in understanding and resolving specific requests while showing patience, empathy, compassion and sincerity.
• Responds to customer questions via inbound and outbound telephone calls and written correspondence.
• Partners with other Sanford Health departments as needed to coordinate on inquiries requiring in depth research to ensure customer satisfaction regarding member and provider questions.
• Thoroughly documents interaction for accurate tracking and analysis.

Customer Service Representative – Health Plan

Manager

• Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a diverse member population while ensuring compliance with CMS, NCQA, and state/federal guidelines.
• Responsible for the day to day oversight of department function both in terms of provision of service and providing direct supervision of all departmental staff.
• Maintains a standardization of utilization management process to ensure all policies and procedures are followed effectively and efficiently.
• Considered an expert resource with the centers for Medicare and Medicaid services (CMS).
• Coordinates authorization/certification of care for designated populations to establish medical necessity and ensure maximum reimbursement while maintaining a high level of customer satisfaction.
• Actively involved in reviewing information submitted by internal or external referral sources regarding a variety of cases which have the potential to develop into complex and/or costly scenarios and assisting the finance department in understanding the financial implications of these conditions.
• Management of medical denials, appeals, and grievances.
• Understand and provide insight into evaluating current process improvement strategies including quality, methods, and ability to maintain focus on the continuous improvement of processes, products and services.
• Manage processes to support attainment of goals within department and organization.
• Knowledgeable of industry standards, governing bodies, and regulations.
• Adjusts to new or changing assignments, processes, and people.
• Being a positive role model for staff to coach, educate and support both the employees and organizational growth.
• Determines individual and team competency requirements, vulnerabilities, and learning needs.
• Assumes management responsibilities such as payroll, scheduling, day-to-day staffing and crucial conversations in collaboration with human resources and leadership.
• Identifies opportunity for personal and professional growth and pursues educational opportunities.

Manager, Health Plan Utilization Management – RN

• Review medical documentation and assign appropriate codes (ICD-10, HCPCS, CPT).
• Ensure compliance with coding standards, regulations, and company procedures.
• Communicate effectively with medical professionals.
• Participate in coding team meetings and serve as a subject matter expert.
• Validate physician charge capture and assist with the appeal process.

Coder, Behavioral Health

Counselor

• Answers billing questions.
• Reviews patient's insurance coverage and Explanation of Benefits (EOBs).
• Provides clarification regarding what charges were incurred and why they were incurred.
• Reviews insurance denials and provides an explanation for the denial to the patient.
• Reviews payment plan guidelines and assists in setting up payment arrangements.
• Determines if patient is eligible for payment assistance programs and assists in the application process, if applicable.
• Educates patients regarding insurance concepts, such as what copayments are, what services are covered, effective dates of coverage, when a referral is needed and the effect on insurance, how to obtain a valid referral and resubmit the claim, and how effective dates of coverage influence insurance payments.
• May assist patient in filling out medical assistance program paperwork, as well as referrals to Medicaid or other insurance aid or disability programs.
• Frequently advises uninsured patients on outstanding medical costs associated with procedures performed in a clinic setting and establishes a payment plan.
• Interacts with patients in-person and must be able to empathize with them while also diffusing strong emotions.
• Calculates and provides cost estimates for medical procedures, including the patient's anticipated share.
• Advises on and collects prepayments for services not covered by insurance. May perform guest service duties, as needed. Other duties as assigned.

Financial Counseling Representative

Consultant

• Provides operational support and training to senior living settings within the field locations.
• Instructs, trains, and provides resources to customers to meet goals and outcomes.
• Provides ongoing training to all new and existing staff members with responsibilities in senior living settings.
• Develops training materials.
• Assists with development and support of policies and procedures and related training materials for senior living settings.
• Provides ongoing operational support to senior living settings as it relates to day-to-day questions regarding housing management, regulatory compliance, etc.
• Assists with training, coordination and general project management to new senior living project start-ups.
• Takes initiative in forming collaborative relationship within and outside of the organization in order to promote housing programs consistent with industry standards.

Senior Living Consultant

• Provide telehealth services involving all ages of patients
• Perform telephone triage, health information, and education
• Provide educational and resource referrals based on patient needs
• Document health information accurately

RN Call Center – Full Time Nights

• Providing telehealth services involving all ages of patients
• Telephone triage; health information and education
• Crisis intervention following established protocols
• Systematic assessment and data collection

RN Call Center – Part Time Nights

Support Engineer

• Performs routine healthcare information system and application support
• Utilizes analytical skills and experiences to investigate or escalate support issues
• Resolves incidents and service requests
• Assists in the creation and maintenance of training documentation
• Incorporates appropriate presentation techniques to support and/or lead training sessions
• Researches, analyzes and makes recommendations for application workflow improvements
• Creates and analyzes reports created using multiple reporting mechanisms
• Gathers, analyzes, designs, develops, modifies, tests, implements, evaluates, and maintains information technologies to support business needs
• Promotes and participates in a team approach
• Works with other departments and outside vendors