Licensing Specialist jobs in Billings, MT

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Authorizations Specialist
  • billingsclinic
  • Billings, MT FULL_TIME
  • Responsible for performing the medication authorization functions with insurance carriers. Coordinate with/educate physicians, nursing staff and other health care providers on the authorization process and requirements. Works as a patient advocate and functions as a liaison between the patient, staff and payer to answer avoid care delays. Tracks, documents, and monitors authorizations. Implements check and balance systems to ensure timely compliance. Processes complete prescription claims including proper adjudication/reconciliation, insurance verification, prior authorization, and compassionate care/medication assistance programs associated with patient accounts and insurance claims billing.

    Essential Job Functions

    •Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
    •Coordinates medication authorization process ensuring authorization has been obtained.
    •Identifies and initiates precertification/authorization requirements for individual payers and communicates with payer sources in a timely manner to obtain necessary pre-certification/authorization.
    •Processes complete prescription claims including proper adjudication/reconciliation, insurance verification, prior authorization, and compassionate care/medication assistance programs associated with patient accounts and insurance claims billing.
    •Enters medication charges and credits for the adjudication/reconciliation of patient accounts and insurance claims billing.
    •Participates in quality improvement activities utilizing performance improvement principles to assess and improve quality.
    •Documents and maintains patient specific precertification/authorization data within the required information systems. Documents and tracks authorizations using established process.
    •Reports denials and/or delays in the precertification/authorization process to physicians/other health care providers and/or the patient.
    •Develops and maintains collaborative working relationships with payers and health care team.
    •Reports non-compliance issues to department specific leadership team.
    •Works with Medical Staff Office validating provider enrollment and NPI numbers.
    •Tracks and verifies that medication precertification/authorization has been received either verbally or written.
    •Communicates status to health care team and patient as needed. Reviews schedules and work lists multiple times throughout the day.
    •Reports medication denials and/or delays in the authorization process to the health care team and the patient. Provides information to the patient on the appropriate appeal process for denials as needed.

    Additional Duties: Concurrent – Authorization
    •Understands insurance/payer policy language, benefits and authorization requirements upon admission, for concurrent review, and for discharge.
    •Coordinates Peer to Peer reviews. Submits letters of medical necessity and follows up on payer denial outcomes.
    •Participates in continuing education, department planning, work teams and process improvement activities.
    •Conducts follow-up calls, as necessary, to third party payers to complete authorization process validating that all days are authorized.
    •Facilitates retro-authorization process with payers. Communicates outcome with patient, physician, Patient Financial Services and other key departments
    •Responsible for coordinating resolution of varied problem situations and performing necessary investigation and research as it relates to the authorization process to resolve pre-certification/authorization problems.
    •Works closely with Payer Relations coordinating needed pre-certification/ authorizations for in-network and out of network services.
    •Maintains reference manuals that outline the individual payer requirements as it relates to precertification and authorization needs while also being responsible for the integrity and accuracy of the payer data.
    •Responsible for the orientation and education of physician, nursing staff, who rely on the pre-certification process.
    •Works with Coding Resources validating correct and billable CPT code, Writes process with critical elements for new procedures and maintains pre-certification instruction manual.
    •Reviews, updates and standardizes forms and processes as needed.
    Initiates workflow for new procedures/service lines.

  • 19 Days Ago

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Maintenance Specialist
  • MAC LTT Manufacturing, Inc
  • Billings, MT FULL_TIME
  • We are seeking a highly skilled individual who can troubleshoot and perform maintenance on manufacturing equipment and the facility. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. (Othe...
  • 21 Days Ago

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Benefits Specialist
  • Billings Clinic Health System
  • Billings, MT OTHER
  • Under general supervision, the incumbent in this position provides administrative, clerical and technical support within the areas of benefits and compensation.Essential Job Functions •Supports and mo...
  • 21 Days Ago

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Merchandiser Specialist
  • Acosta Group
  • Cody, WY FULL_TIME
  • **Start your career with Premium.** \#WeArePremium **Merchandiser Specialist** **General Information** **Company:** PRE-US **Location:** CODY, Wyoming, 82414 **Ref #:** 25308 **Function:** Merchandisi...
  • 22 Days Ago

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Authorizations 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...
  • 22 Days Ago

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Insurance specialist
  • BMO Financial Group
  • Billings, MT FULL_TIME
  • BMO is hiring an Insurance Claims Specialist to join the Transportation Finance Operations team. BMO Transportation Finance serves the entire supply chain of the transportation industry, including ori...
  • 23 Days Ago

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0 Licensing Specialist jobs found in Billings, MT area

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Health Information Management (HIM) Specialist
  • Billings Clinic
  • Billings, MT
  • Youll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a v...
  • 3/29/2024 12:00:00 AM

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Youth Case Manager
  • Youth Dynamics
  • Billings, MT
  • Vacancy Name Youth Case Manager Vacancy No VN1858 Basis Full-Time Job Details What You'll Do: Youth Case Managers are th...
  • 3/29/2024 12:00:00 AM

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Travel Nurse RN - Labor and Delivery - $2,122 per week
  • Adventist Health
  • Billings, MT
  • RNnetwork is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Billings, Montana. Job Description...
  • 3/28/2024 12:00:00 AM

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Travel Nurse RN - Med Surg - $1,967 per week
  • Adventist Health
  • Billings, MT
  • RNnetwork is seeking a travel nurse RN Med Surg for a travel nursing job in Billings, Montana. Job Description & Require...
  • 3/28/2024 12:00:00 AM

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Oncology Regional Medical Scientific Director - Thoracic Malignancies - WA, OR, MT, ID, WY, AK (Remote)
  • Merck & Co., Inc.
  • Billings, MT
  • Job Description Role Summary: * The Oncology Regional Medical Scientific Director (RMSD) is a credentialed (i.e., PhD, P...
  • 3/27/2024 12:00:00 AM

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Provider Enrollment Specialist
  • Billings Clinic
  • Billings, MT
  • Youll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a v...
  • 3/26/2024 12:00:00 AM

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Facility Technician
  • SYSCO
  • Billings, MT
  • Company: US0043 Sysco Montana, Inc. Zip Code: 59101 Minimum Level of Education: High School or Equivalent Minimum Years ...
  • 3/25/2024 12:00:00 AM

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Merchandising & Product Demonstration Specialist
  • SAS Retail Services
  • Billings, MT
  • Join our dynamic team as a Merchandising & Product Demonstration Specialist! In this multifaceted role, you'll excel in ...
  • 8/25/2023 12:00:00 AM

Billings is the largest city in the U.S. state of Montana, with a population estimated at 109,642 as of 2017. Located in the south-central portion of the state, it is the seat of Yellowstone County and the principal city of the Billings Metropolitan Area, which has a total a population of 170,498. It has a trade area of over 500,000. Billings was nicknamed the "Magic City" because of its rapid growth from its founding as a railroad town in March 1882. The city is named for Frederick H. Billings, a former president of the Northern Pacific Railroad. With one of the largest trade areas in the Uni...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Licensing Specialist jobs
$44,332 to $59,816
Billings, Montana area prices
were up 3.1% from a year ago

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