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PreAccess Specialist I

Methodist Health System Omaha, NE
  • Purpose of Job
    • 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.
  • 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
        • Lifting
        • Pulling/Pushing
        • Standing
        • Stooping/bending
        • Twisting
        • Walking
      • Frequently Performed (34%-66%):
        • Fingering/Touching
        • Grasping
        • Keyboarding/typing
        • Reaching
        • Repetitive Motions
        • Sitting
        • Speaking/talking
      • Constantly Performed (67%-100%):
        • Hearing
        • Seeing/Visual

    • Job Hazards
      • Not Related:
        • Chemical agents (Toxic, Corrosive, Flammable, Latex)
        • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
        • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
        • Equipment/Machinery/Tools
        • Explosives (pressurized gas)
        • Electrical Shock/Static
        • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
        • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
        • Mechanical moving parts/vibrations
  • Essential Job Functions
    • Essential Functions I

      • 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.

    • Essential Functions II

      • Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.

      • Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.

      • Other duties as assigned.

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Date Posted June 30, 2022
Date Closes August 29, 2022
Requisition 24017
Located In Omaha, NE
SOC Category 00-0000.00

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