Pre-Access Specialist I

Bestcare; Omaha, Northern (NE, KY); Hybrid; USD 36,000 - 48,000; Full time

Job summary

Nebraska Methodist Health System is seeking a detail-oriented Eligibility Specialist for the Methodist Corporate Office in Omaha. You will verify benefits, perform medical necessity checks, and maintain accurate EMR documentation for diagnostic procedures.

Required is a High School/GED and 1+ year EMR experience, with preferred credentials in clinical health information management. The role supports patient access through precise, compliant processing and communication.

Qualifications

• 1+ year of clinical experience using electronic medical records (EMR).
• Registration, insurance, or prior-authorization experience preferred.
• Knowledge of Medicare requirements and medical terminology.
• Ability to perform numerical calculations and maintain accuracy.

Responsibilities

• Verify eligibility and obtain benefit information for diagnostic procedures and testing.
• Provide initial clinical documentation as requested.
• Update demographic and insurance information in EMR.
• Perform medical necessity checks to determine reasonableness and necessity based on diagnosis.
• Create cost estimates for diagnostic procedures and testing.
• Process pre-certification, authorization and referrals.
• Ensure documentation is current in EMR and notation for patient signatures when needed.

Skills

Computer literacy

Organizational skills

Verbal and written communication

Medical terminology

Microsoft Office

ICD-10 knowledge

Mathematical calculations

Education

High school diploma or GED

Post-secondary clinical education or health information management preferred

Tools

EMR systems

Electronic medical records

Job description

**Why work for Nebraska Methodist Health System?** 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 Corporate Office Address: 825 S 169th St. - Omaha, NE Work Schedule: Mon - Fri, 8:00am to 4:30pm 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.**Responsibilities:****Essential Job Functions**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.**Schedule:**Mon - Fri, 8:00am to 4:30pm**Job Description:****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**About Methodist:**Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.