Magnet:

Commitment to Nursing Excellence\nBillings Clinic is proud to be recognized for nursing excellence as a Magnet®-designatedanization, joining only 97 otheranizations worldwide that have achieved this honor four times. The re-designation process happens every four years. to learn more!\nPre-Employment Requirements\nAll new employees mustplete several pre-employment requirements prior to starting. to learn more!\nPre-Certification Specialist (Full-time)\n

PRE-ACCESS

(ROCKY

MOUNTAIN PROFESSIONAL BUILDING

)\nreq11765\n

Shift:

Day\n

Employment Status:

Full-Time (.75 or greater)\nHours per

Pay Period:

1.00 = 80 hours every two weeks (Non-Exempt)\n

Starting Wage:

$17.15 to $21.44 per hour\nResponsible for thepletion 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. May provide back-up pre-certification/prior authorization resources for other departments as needed. Coordinates/educates physicians, nursing staff and other health care providers on the pre-certification process and requirements. Tracks, documents, and monitors pre-certifications. Implements checks and balance systems to ensurepliance.\nEssential Job Functions\n

Supports and practices the mission and philosophy of Billings Clinic and Radiology Department.\n
Coordinates pre-certification process with provider offices to ensure target goal of 98% of pre-scheduled elective inpatient and outpatient procedures are pre-authorized.\n
Documents and maintains patient specific pre-certification/authorization data within the required information systems. Compiles, documents, and tracks monthly pre-certifications using established procedures.\n
Keeps undated list. Ensures correct patient status when pre-certifying.\n
Reviews CPT-4 codes of required pre-certification and/or authorizations; ensuring Passport pre-certification process is also met.\n
s 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.\n
Responsible for coordinating resolution of varied problem situations and performing necessary investigation and research to resolve pre-certification problems.\n
s nonpliance issues and/or needs for program expansion to Manager.\n
Works closely with Medical Staff, Payer Relations and Patient Financial Services to coordinate needed pre-certification authorizations for in-network services.\n
Tracks and verifies receipt of pre-certification authorizations has been received either verbally or written. Communicates status to providers and patients as needed.\n
Develops and maintains collaborative working relationships with payers and health care providers.\n
Reviews, updates and standardizes forms and processes as needed\n
Participates in interdepartmental meetings to coordinate efforts, work through processes, and fostermunication.\n
Develops and maintains reference manuals that outline the individual payer requirements as it relates to pre-certification and pre-authorization needs.\nResponsible for the integrity and accuracy of the payer data\n
Assists patients/family members with status of pre-certification or re-certification information.\n
Identifies needs and sets goals for own growth and development; meets all mandatory system/department requirements. Maintains knowledge of current trends and developments as it relates to the pre-certification process.\n
Maintainspetency in allanizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.\n
Performs other duties as assigned or needed to meet the needs of the departmentanization.\nMinimum Qualifications\nEducation\n
High school graduate or equivalent\nExperience\n
One (1) year of medical insurance claims experience through patient accounts billing or claims adjudication\nBillings Clinic is Montana's largest health system serving Montana, Wyoming and the western Dakotas.

A not-for-profitanization led by a physician CEO, the health system is governed by a board ofmunity members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. /aboutus\nBillings Clinic ismitted to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.\nBillings Clinic Human Resources, PO Box 37000, Billings, MT 59107-7000\n

Street Address:

Billings Clinic, 801 North 29th St., Billings, MT 59101\n

E-mail:

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