Job Posting for Radiology Pre-Certification Specialist at billingsclinic
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.
Salary.com Estimation for Radiology Pre-Certification Specialist in BILLINGS, MT
$78,509 to $100,973
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