Pre-Certification Specialist (Full-time)

Billings Clinic Opportunity

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.

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 and how we are recognized nationally for our exceptional quality.

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.

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.

All new employees must complete several pre-employment requirements prior to starting.

Shift: Day Employment Status: Full-Time (.75 or greater) Hours per Pay Period: 1.00 = 80 hours every two weeks (Non-Exempt) Starting Wage: $17.00 to $21.25 per hour commensurate on experience

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. 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 ensure compliance.

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. Reviews, updates and standardizes forms and processes as needed Participates in interdepartmental meetings to coordinate efforts, work through processes, and foster communication. Develops and maintains reference manuals that outline the individual payer requirements as it relates to pre-certification and pre-authorization needs. Responsible for the integrity and accuracy of the payer data Assists patients/family members with status of pre-certification or re-certification information. 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. Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance. Performs other duties as assigned or needed to meet the needs of the department/organization.

Education: High school graduate or equivalent

Experience: One (1) year of medical insurance claims experience through patient accounts billing 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.

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.