Pre-Access & Insurance Verification Specialist

CO800 Methodist Physicians Clinic; United States; On-site; USD 42,000 - 65,000; Full time

Job summary

Nebraska Methodist Health System is seeking an Eligibility Specialist to determine eligibility and costs for diagnostic procedures. You will ensure documentation is current for payors and clinical staff, perform medical necessity checks, and manage pre-certification workflows in the EMR environment.

The role emphasizes accurate data entry, communication with providers, and adherence to Medicare/MHP guidelines while supporting efficient patient care processes.

Qualifications

• Education: High School diploma or GED; clinical post-secondary education preferred.
• Experience: 1 year of clinical EMR use and documentation.
• Skills: knowledge of medical terminology, coding basics, and communication.

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 checks for reasonableness and necessity.
• Document medical necessity checks and outcomes.
• Create cost estimates and note patient responsibility in EMR.

Skills

Eligibility

Documentation

EMR

CPT ICD10 coding

Medicare knowledge

Microsoft Office

Education

High School Diploma

Clinical post-secondary education preferred

Job description

Nebraska Methodist Health System is seeking an Eligibility Specialist to determine eligibility and costs for diagnostic procedures. You will ensure documentation is current for payors and clinical staff, perform medical necessity checks, and manage pre-certification workflows in the EMR environment.

The role emphasizes accurate data entry, communication with providers, and adherence to Medicare/MHP guidelines while supporting efficient patient care processes.