Member Certification Specialist jobs in Montana

Member Certification Specialist coordinates the certification and credentialing programs of a professional or membership organization. Participates in the development of standards and the creation of testing materials. Being a Member Certification Specialist maintains and monitors a test scheduling system or database. Organizes resources to implement testing schedules and sessions, including locations, testers, technology, and materials. Additionally, Member Certification Specialist assists members with information about programs and resolves any issues with the process. Interfaces with and monitors outside testing providers. May require a bachelor's degree. Typically reports to a manager. The Member Certification Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Member Certification Specialist typically requires 2-4 years of related experience. (Copyright 2024 Salary.com)

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Radiology Pre Certification Specialist
  • Billings Clinic
  • Billings, MT FULL_TIME
  • 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.

    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.

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

    Radiology Pre Certification Specialist
    RADIOLOGY ADMINISTRATION (Billings Clinic Main Campus)
    req5409

    Shift: Day, Evenings, Nights, Weekends
    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 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 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.

    Minimum Qualifications
    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. 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.

  • 10 Days Ago

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Radiology Pre-Certification Specialist
  • billingsclinic
  • BILLINGS, MT FULL_TIME
  • 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 ...
  • 10 Days Ago

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Radiology Pre-Certification Specialist
  • billingsclinic
  • Billings, MT FULL_TIME
  • 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 ...
  • 15 Days Ago

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Pre-Certification Specialist - Surgery Center
  • Billings Clinic
  • Billings, MT FULL_TIME
  • 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...
  • 10 Days Ago

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Internal Audit & Compliance Analyst
  • Member Driven Technologies
  • Great Falls, MT OTHER
  • Job Details Job Location: Great Falls Office - Great Falls, MT Salary Range: Undisclosed Description Salary Range: $55,000 – 65,000 (Based on Professional Experience) POSITION LOCATION This position i...
  • 20 Days Ago

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Consultant
  • Member Driven Technologies
  • Great Falls, MT FULL_TIME
  • POSITION LOCATION This position is eligible for a hybrid work arrangement. Currently 5 days of on-site work per month are required. POSITION PURPOSE Deliver measurable results through working with cre...
  • 10 Days Ago

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Quality Certification Specialist
  • ATI
  • Albany, OR
  • Job Description Proven to Perform. From the edges of space to the bottoms of ocean, our materials are proven to perform ...
  • 3/29/2024 12:00:00 AM

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WIC Certification Specialist (WI0807 - Potranco)
  • Communicaresa
  • San Antonio, TX
  • ** WIC Certification Specialist (WI0807 - Potranco)** **Job Category****:** Tech **Requisition Number****:** WICCE002683...
  • 3/29/2024 12:00:00 AM

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MWBE Certification Specialist
  • HCL Global Systems Inc.
  • LOCALS TO IN, ON-SITE & IN-PERSON INTERVIEWS Job Requirements: Preferably have a legal background; J.D. or Paralegal cer...
  • 3/27/2024 12:00:00 AM

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High School Credit Recovery (Summer School) Administrator - Certificated Employees ONLY
  • Oceanside Unified
  • Oceanside, CA
  • Requirements / Qualifications Valid California Administrative Services Credential (REQUIRED) Applicants must have access...
  • 3/27/2024 12:00:00 AM

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Intake-Certification Specialist-GPD
  • AMERICAN GI FORUM NATIONA
  • Fort Worth, TX
  • Job Description Job Description About the Company American GI Forum - National Veterans Outreach Program is a nonprofit ...
  • 3/26/2024 12:00:00 AM

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3 rd Party Certification Specialist / Laboratory Technician
  • ABCO Laboratories Inc.
  • Fairfield, CA
  • ABCO LABORATORIES, INC. 3 rd Party Certification Specialist / Laboratory Technician ABCO Laboratories is a contract manu...
  • 3/26/2024 12:00:00 AM

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Quality Certification Specialist
  • DYNAMIC FLOWFORM CORP.
  • Albany, OR
  • Job Description Proven to Perform. From the edges of space to the bottoms of ocean, our materials are proven to perform ...
  • 3/25/2024 12:00:00 AM

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Certification Specialist
  • Aging True Senior Services
  • Jacksonville, FL
  • Job Description Job Description Summary: Helping to maintain people’s independence is the cornerstone philosophy of Meal...
  • 3/25/2024 12:00:00 AM

Montana (/mɒnˈtænə/ (listen)) is a landlocked state in the Northwestern United States. Montana has several nicknames, although none are official, including "Big Sky Country" and "The Treasure State", and slogans that include "Land of the Shining Mountains" and more recently "The Last Best Place". Montana is the 4th largest in area, the 8th least populous, and the 3rd least densely populated of the 50 U.S. states. The western half of Montana contains numerous mountain ranges. Smaller island ranges are found throughout the state. In all, 77 named ranges are part of the Rocky Mountains. The easte...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Member Certification Specialist jobs
$64,345 to $99,625

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