Montana Staffing
Pre-Certification Specialist (Full-Time)
Billings Clinic is looking for a Pre-Certification Specialist for our Pre-Access team at Billings Clinic Bozeman Ambulatory. This position is full-time (.75 or greater) with a starting wage of $17.15 - $21.44 DOE. The Pre-Certification Specialist is responsible for the completion of pre-certification, prior authorization, and notification for third party and government payers for all pre-scheduled elective inpatient and outpatient examination and procedures requiring preauthorization. They may also provide back-up pre-certification/prior authorization resources for other departments as needed. This role coordinates/educates physicians, nursing staff, and other health care providers on the pre-certification process and requirements. They track, document, and monitor pre-certifications and implement checks and balance systems to ensure compliance. Essential Job Functions: Supports and practices the mission and philosophy of Billings Clinic and Radiology Department. Coordinates pre-certification process with provider offices to ensure target goal of 98% of pre-scheduled elective inpatient and outpatient procedures are pre-authorized. Documents and maintains patient specific pre-certification/authorization data within the required information systems. Compiles, documents, and tracks monthly pre-certifications using established procedures. Keeps undated list. Ensures correct patient status when pre-certifying. Reviews CPT-4 codes of required pre-certification and/or authorizations; ensuring Passport pre-certification process is also met. Reports denials and/or delays in the pre-certification process to physicians/other health care providers and the patient. May provide information to the patient on the appropriate appeal procedures for denials. Responsible for coordinating resolution of varied problem situations and performing necessary investigation and research to resolve pre-certification problems. Reports non-compliance issues and/or needs for program expansion to Manager. Works closely with Medical Staff, Payer Relations, and Patient Financial Services to coordinate needed pre-certification authorizations for in-network services. Tracks and verifies receipt of pre-certification authorizations has been received either verbally or written. Communicates status to providers and patients as needed. Develops and maintains collaborative working relationships with payers and health care providers.
Billings Clinic is looking for a Pre-Certification Specialist for our Pre-Access team at Billings Clinic Bozeman Ambulatory. This position is full-time (.75 or greater) with a starting wage of $17.15 - $21.44 DOE. The Pre-Certification Specialist is responsible for the completion of pre-certification, prior authorization, and notification for third party and government payers for all pre-scheduled elective inpatient and outpatient examination and procedures requiring preauthorization. They may also provide back-up pre-certification/prior authorization resources for other departments as needed. This role coordinates/educates physicians, nursing staff, and other health care providers on the pre-certification process and requirements. They track, document, and monitor pre-certifications and implement checks and balance systems to ensure compliance. Essential Job Functions: Supports and practices the mission and philosophy of Billings Clinic and Radiology Department. Coordinates pre-certification process with provider offices to ensure target goal of 98% of pre-scheduled elective inpatient and outpatient procedures are pre-authorized. Documents and maintains patient specific pre-certification/authorization data within the required information systems. Compiles, documents, and tracks monthly pre-certifications using established procedures. Keeps undated list. Ensures correct patient status when pre-certifying. Reviews CPT-4 codes of required pre-certification and/or authorizations; ensuring Passport pre-certification process is also met. Reports denials and/or delays in the pre-certification process to physicians/other health care providers and the patient. May provide information to the patient on the appropriate appeal procedures for denials. Responsible for coordinating resolution of varied problem situations and performing necessary investigation and research to resolve pre-certification problems. Reports non-compliance issues and/or needs for program expansion to Manager. Works closely with Medical Staff, Payer Relations, and Patient Financial Services to coordinate needed pre-certification authorizations for in-network services. Tracks and verifies receipt of pre-certification authorizations has been received either verbally or written. Communicates status to providers and patients as needed. Develops and maintains collaborative working relationships with payers and health care providers.