Pre-Access Specialist

Position: Pre-Access Specialist I
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge.

We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.
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* Job Summary:

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* Location:

Methodist Corporate Office   Address: 825 S 169th St.

- Omaha, NE

Work Schedule:

9:00 AM - 5:30 PM    Perform a variety of duties to determine eligibility and costs for diagnostic procedures and testing. Ensure documentation is current and accurate for payors and clinical staff.
** Responsibilities:
**** Essential Job Functions
** Verify eligibility and obtain benefit information for diagnostic procedures and testing.
* Provide initial clinical documentation as requested.
* Update demographic and/or insurance information.

Perform medical necessity check to determine in advance if the procedure or treatment is reasonable and necessary based on diagnosis.
* Document medical necessity checking outcome.
* Generate waiver/ Advanced Beneficiary Notice (ABN) if medical necessity checking does not meet payer criteria.
* Scan waiver documentation into electronic medical record.
* Ensure notation is made for any documents that require patient signature.
* Accurately screens all applicable Medicare tests.
* Reviews Medicare Secondary Payor (MSP) queries to determine payor for Medicare and Medicare HMO patients.

Initiate pre-certification process for diagnostic procedures and testing.
* Ensure all pertinent information is added to electronic medical record (EMR).
* Clarify orders or documents from providers to ensure that CPT and ICD-10 code is correct for procedure ordered and is authorized.
* Retrieve and submit clinical information.
* Provide communication when additional information is required, eligibility failed, medical necessity isn’t supported or precertification wasn’t approved.

Create cost estimate for diagnostic procedures and testing.
* Documents estimated patient responsibility in EMR.Ensure all pre-certification, authorization and referral requirements have been completed prior to scheduled procedure.
* Obtain additional clinical information as needed.

Maintain reference materials to ensure accuracy of information.
* Sets priorities that benefit the department and organizes time to complete the tasks.
* Can quickly adapt when new processes are introduced and/or existing processes are modified.

Maintain productivity and quality standards as defined through the organizational and departmental goals and objectives.
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* Schedule:

** 9:00 - 5:30
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* Job Description:

**** Job Requirements
**** Education
* ** High School or GED required.
* Post-Secondary education in a clinical field (e.g., RN, CNA, Radiologist Technologist, Phlebotomist, etc.) or health information management preferred.
** Experience
* ** Minimum 1 year of clinical experience using electronic medical records required.
* Registration, insurance, or prior-authorization experience preferred.
** License/Certifications
*** N/A
** Skills/Knowledge/Abilities
*** Skill using computers and office equipment.
* Skill organizing and prioritizing work.
* Skill with verbal and written communication.
* Knowledge of medical terminology.
* Knowledge of Microsoft Office suite.
* Knowledge of Medicare requirements.
* Basic knowledge of ICD 10/CPT coding.
* Ability to perform mathematical calculations.
* Ability to adhere to all workplace and safety requirements, regulations, standards, and practices
** Physical Requirements
**** Weight Demands
*** Light Work - Exerting up to 20 pounds of force.
** Physical Activity
*** Not necessary for the position (0%):  + Climbing  + Crawling  + Kneeling
* Occasionally Performed (1%-33%):  + Balancing  + Carrying  + Crouching  + Distinguish colors  +…