Pre-Access Specialist I: Eligibility & Preauth

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

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.