PreAccess Specialist

​Methodist Physicians Clinic

Introduction:

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 Description:

  • 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 estimates 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.
  • 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.

Required Qualifications:

Minimum 1 year of clinical experience using electronic medical records required.

Preferred Qualifications:

  • Registration, insurance, or prior-authorization experience preferred.
  • Post-Secondary education in a clinical field (e.g., RN, CNA, Radiologist Technologist, Phlebotomist, etc.) or health information management preferred.

Education Qualifications:

  • High School or GED required.

Instructions for Resume Submission:

Apply Online: https://pm.healthcaresource.com/cs/methodisths/#/job/21565