Pre-Access Specialist

Best Care•Council Bluffs, IA

3d•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. 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. Job Summary: Location: Methodist Physicians Clinic - 1 Edmundson Place - Methodist Jennie Edmundson Hospital Address: 933 E. Pierce St. - Council Bluffs, IA Work Schedule: Mon - Fri, full time, business hours 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.

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 preferred.
Registration, insurance, or prior-authorization experience preferred.

Responsibilities

Serve as an advocate for new patients to Methodist Physicians Clinic.
Creates patient estimates.
Speaks directly with each patient to review estimated cost of care and payment policies.
Assists with FMLA, Disability or other forms in a timely manner.
Verify benefits and obtains authorization using electronic sources to improve efficiency in obtaining authorizations ensuring timely care is provided.
Document medical necessity checking outcome.
Generate waiver / Advanced Beneficiary Notice (ABN) if medical necessity checking does not meet payer criteria, patient is seeking care for a non-covered benefit, or a self-pay patient.
Assists, counsels, and suggests problem solving techniques to patients as they relate to prompt payment of accounts by following department policies to ensure timely resolution of account.
Processes paperwork by reviewing accounts that have filed bankruptcy then forwards to the immediate supervisor for adjustment.
Provides patient assistance when needed regarding resolving billing issues, refund, or collection problems, insurance questions including Medicare/Medicaid by following established policies for account resolution and patient satisfaction.
Assists patients with community resources when needed.
Works with drug companies when needed to secure financial assistance for patients.
Assists patients with Every Women Matters.
Manages patient accounts.
Responsible for the proper documentation on patient accounts regarding financial arrangements, insurance coverage, special instructions from physicians, and other pertinent information needed to ensure proper handling of the account.
Verifies insurance or determine if self-pay.
Set up account and payment plans.
Monitors payments.
Complete work associated with insurance change during.
Responsible for the daily deposit and daily return mail.
Open safe in am and distribute bags.
Secure bags at end of day in safe.
Prepare daily deposit for pick up.
Reviews daily return mail by checking status of accounts on computer and determines any action to be taken using appropriate skip tracing techniques to facilitate timely billing of patients.
Maintains patient confidentiality within the area by following office procedures to ensure all information is correct.
Effectively communicates with other department personnel, nurses, physicians, attorneys, insurance companies, and all other parties, by phone or mail, to maintain professional handling of all situations in relation to patients' accounts.