Radiology Pre-Certification Specialist
2 months ago
You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006.
And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine
You can make a difference here.
About Us
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more
about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.
Your Benefits
We provide a comprehensive and competitive benefits package to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more. Click here
for more information or download the Employee Benefits Guide .
Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here
to learn more
Pre-Employment Requirements
All new employees must complete several pre-employment requirements prior to starting. Click here
to learn more
Radiology Pre-Certification Specialist
Billings Clinic (BILLINGS CLINIC HOSPITAL)
req6165
Shift:
Day
Employment Status:
Full-Time (.75 or greater)
Hours per Pay Period:
1.00 = 80 hours (Non-Exempt)
Starting Wage:
$15.00
Responsible for the completion ofpre-certification, prior authorization and notification for third party andgovernment payers for all pre-scheduled elective inpatient and outpatientexamination and procedures requiring preauthorization. May provide back-uppre-certification/prior authorization resources for other departments asneeded. Coordinates/educates physicians, nursing staff and other health careproviders on the pre-certification process and requirements. Tracks, documents,and monitors pre-certifications. Implements checks and balance systems toensure compliance.
Essential Job Functions
•Supports and practices the mission and philosophy ofBillings Clinic and Radiology Department.
•Coordinates pre-certification process with provider officesto ensure target goal of 98% of pre-scheduled elective inpatient and outpatientprocedures are pre-authorized.
•Documents and maintains patient specificpre-certification/authorization data within the required information systems.Compiles, documents, and tracks monthly pre-certifications using establishedprocedures.
•Keeps undated list. Ensures correct patient status whenpre-certifying.
•Reviews CPT-4 codes of requiredpre-certification and/or authorizations; ensuring Passport pre-certificationprocess is also met.
•Reports denials and/or delays inthe pre-certification process to physicians/other health care providers and thepatient. May provide information to the patient on the appropriate appealprocedures for denials.
•Responsible for coordinatingresolution of varied problem situations and performing necessary investigationand research to resolve pre-certification problems.
•Reports non-compliance issuesand/or needs for program expansion to Manager.
•Works closely with Medical Staff,Payer Relations and Patient Financial Services to coordinate neededpre-certification authorizations for in-network services.
•Tracks and verifies receipt ofpre-certification authorizations has been received either verbally or written.Communicates status to providers and patients as needed.
•Develops and maintainscollaborative working relationships with payers and health care providers.
•Reviews, updates and standardizesforms and processes as needed
•Participates in interdepartmentalmeetings to coordinate efforts, work through processes, and fostercommunication.
•Develops and maintains reference manuals that outline theindividual payer requirements as it relates to pre-certification andpre-authorization needs.
Responsible for the integrity and accuracy of the payer data
•Assists patients/family members with status ofpre-certification or re-certification information.
•Identifies needs and sets goals for own growth anddevelopment; meets all mandatory system/department requirements. Maintainsknowledge of current trends and developments as it relates to thepre-certification process.
•Maintains competency in all organizational, departmental andoutside agency environmental, employee or patient safety standards relevant tojob performance.
•Performs other duties as assigned or needed to meet theneeds of the department/organization.
Minimum Qualifications
Education
•Highschool graduate or equivalent
Experience
•One (1) year of medical insurance claims experience through patient accountsbilling or claims adjudication
Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at www.billingsclinic.com/aboutus
Billings Clinic is committed 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.
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Human Resources is located on the corner of North 29th and 8th Avenue North. Enter through the main entrance to the building and go to the lower level. Human Resources is located at the bottom of the main entrance staircase to the right.
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