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Methodist Physcians Clinic
Location: Omaha, Nebraska
Work Setting: Other
Job Function: Other
Job Type: Full-Time
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.
– 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
– 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
– 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
– 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.
Minimum 1 year of clinical experience using electronic medical records required.
– 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.
– High School or GED required.
Posted: November 3, 2021 at 10:41 AM
Post ID: 64103