Pre-Certification Specialist

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. 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. for more information or .

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. to learn more!

Pre-Employment Requirements
All new employees must complete several pre-employment requirements prior to starting. to learn more!

Pre-Certification Specialist (Full-time)
PRE-ACCESS (ROCKY MOUNTAIN PROFESSIONAL BUILDING)
req
11375

Shift: Day
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours every two weeks (Non-Exempt)
Starting Wage: $15.00

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.

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…