Pre-Access Specialist I

About the role

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!

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.
• Maintain productivity and quality standards as defined through the organizational and departmental goals and objectives.

Requirements

• 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.
• Minimum 1 year of clinical experience using electronic medical records required.
• Registration, insurance, or prior-authorization experience preferred.

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%).
• Frequent Activities: Carrying, Lifting, Pulling/Pushing, Standing, Walking, Fingering/Touching, Grasping, Keyboarding/typing, Reaching, Repetitive Motions, Sitting.
• Equipment/Machinery/Tools: None.
• Physical Hazards: None.

Job Description

Schedule: Mon - Fri, 8:00am to 4:30pm