Pre-Access Coordinator

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. Its helping families grow by making each delivery special conveying a difficult diagnosis with a compassionate touch going above and beyond for a patients 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:

Responsibilities:

Essential Job Functions

Ensures prior authorization obtained for designated scheduled cases to support denial prevention.

• Monitors preaccess daily report and allocates team resources as needed to meet department goals.
• Utilizes the preaccess report to identify trends in authorization delays based on date scheduled and date authorization obtained.
• Monitors and assigns add on same day next day procedure.
• Maintains consistent rotation of same day encounters.
• Completes prior authorizations for same day appointments as needed.

Monitors quality assurance.

• Audits completed cases for accuracy required scripting and appropriate follow up with payer/providers correct procedure codes and payer loaded.
• Follows up with team members if additional activities/information is required to support preaccess and denial prevention.
• Proactively works with clinic providers and coding to educate and reduce future denials.
• Communicates with leadership the results of quality audit trends.

Functions as the primary day to day resource for Preaccess Specialist staff.

• Acts as the department resources for preaccess processes related to day to day operations.
• Triages day to day system issues to the appropriate departments or contacts.
• Communicates information obtained from payer representatives to revenue cycle training (RCT).

Functions as the primary trainer for preaccess staff members.

• Leads both group and one-on-one training for team members.
• Trains new staff members in preaccess process (verification cost estimation and prior authorizations).
• Follows designated training checklist providing feedback to leadership regarding team members training status ongoing training objectives further development and effectiveness of training and individual growth.
• Collaborates with leadership to develop training plans workflow processes and department reference materials.
• Coordinates educational opportunities for team members. (Example - webinars payer updates etc.).
• Communicates payer changes to staff members and updates reference materials.

Functions as the primary trainer for onboarding new services and/or work tools.

• Collaborates with leadership to evaluate system resources required for onboarding new services.
• Assists in developing actions plans for testing and onboarding of new services.
• Collaborates with leadership to develop training materials and reference guides for new tools functions directions print screens etc.
• Trains preaccess team members on new workflow process or tools; i.e. use of new tools new scripting or scripting changes methods of denial prevention etc.
• Reports and delays or barriers for implementation.

Facilitates customer service and provider relations.

• Triages and processes customer service requests as appropriate.
• Collaborates with providers office regarding obtaining information required for preaccess or obtaining medical necessity approval from payer when preaccess staff has made every attempt to resolve.
• Notifies leadership if additional communication/collaboration is needed with provider offices.
• Alerts Patient Financial Counselor (PFC) team members of delay in cost estimations process errors or price discrepancy trends.

Performs the duties of a preaccess staff member.

• Works cases as needed to support team goals.
• Verifies patient demographics insurance plans/player source eligibility and benefits.
• Obtains certification/authorization according to payer guidelines.
• Verifies medical necessity and creates cost estimates for designated procedures.

Schedule:

Mon - Fri either 8:00am to 4:30pm or 8:30am to 5:00pm

Job Description:

Job Requirements

Education

• High School Diploma or General Educational Development (G.E.D.) required.
• Associates degree in Health Information Management or other relevant business related preferred.

Experience

• Minimum of 5 year experience in clinic billing or pre-authorization required.

License/Certifications

• Certified Professional Coder (CPC) certification is preferred.

Skills/Knowledge/Abilities

• Knowledge and understanding of medical terminology documentation progress notes and other medical reports/results required.
• Knowledge of treatment guidelines medical necessity and reimbursement criteria required.
• Extensive knowledge of payer guidelines and tools.
• Excellent written and oral communication skills required.
• Ability to communicate requirements to physicians nurses and clinical managers and gain their cooperation in the authorization/pre-certification process.
• Ability to handle intense multiple priorities successfully and adapt quickly with an understanding of the reimbursement failure/consequences if the job is not performed correctly.
• Strong interpersonal and customer service skills with the ability to collaborate with coworkers providers and patients to ensure the highest satisfaction levels and outcomes.
• Skill in problem solving in informal and formal settings.
• Strong computer skills (proficient in Word Excel and Outlook).

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
  • Crouching
  • Distinguish colors
  • Lifting
  • Speaking/talking
  • Standing
  • Stooping/bending
  • Twisting
  • Walking
• Frequently Performed (34%-66%):
  • Fingering/Touching
  • Grasping
  • Keyboarding/typing
  • Pulling/Pushing
  • Reaching
  • Repetitive Motions
  • Sitting
• 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.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race color religion sex age national origin disability veteran status sexual orientation gender identity or any other classification protected by Federal state or local law.