Pre-Access Specialist I

Best Care•Omaha, NE

1d•Onsite

About The Position

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. The Pre-Access Specialist I performs a variety of duties to determine eligibility and costs for diagnostic procedures and testing, ensuring documentation is current and accurate for payors and clinical staff.

Requirements

High School or GED required.
Minimum 1 year of clinical experience using electronic medical records required.
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.

Nice To Haves

Post-Secondary education in a clinical field (e.g., RN, CNA, Radiologist Technologist, Phlebotomist, etc.) or health information management.
Registration, insurance, or prior-authorization experience.

Responsibilities

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.