Member Certification Manager jobs in Billings, MT

Member Certification Manager manages the certification and credentialing programs of a professional or membership organization. Oversees the development of standards and testing materials. Being a Member Certification Manager develops testing schedules and resource requirements to deliver testing. Collaborates with curriculum designers and instructors to ensure materials present certification requirements accurately and are validated in the certification processes. Additionally, Member Certification Manager develops quality processes to ensure the testing and validation processes accurately measure certification requirements. Optimizes the certification process to ensure members are satisfied and resolves any problems related to the process. May evaluate, select, and monitor outside testing providers to ensure testing quality. May require a bachelor's degree. Typically reports to a head of a unit/department. The Member Certification Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Member Certification Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (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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Member Experience Manager
  • Girl Scouts of Montana and Wyoming
  • Billings, MT FULL_TIME
  • Join Our Collaborative Team! At Girl Scouts of Montana and Wyoming, we offer amazing opportunities for talented, forward-thinking individuals who share our vision of helping girls and young women chan...
  • 3 Days Ago

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Fitness Manager - Member Experience Manager- Personal Training Manager- Shiloh
  • Anytime Fitness
  • Billings, MT FULL_TIME
  • Why Join Our Anytime Fitness Team?Let’s grow together, and become better together! We strive to be the best professionals in the fitness industry. We are a high energy team that will do anything we ca...
  • 15 Days Ago

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0 Member Certification Manager jobs found in Billings, MT area

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Aviation Lead in Training - Aviation
  • KLJ
  • Billings, MT
  • Who we are Here at KLJ, we are Safe, Inclusive, Learners, Performers and Owners. We care that you get home safely. Every...
  • 3/29/2024 12:00:00 AM

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Junior Project Manager/Coordinator
  • Lincoln Search Consultants
  • Billings, MT
  • Jr. Project Manager/Coordinator Billings, Montana We are seeking motivated individuals to assist in our rapidly growing ...
  • 3/29/2024 12:00:00 AM

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Biometric Screener/Registration Coordinator (Wellness Worker) - North Central Region
  • Labcorp
  • Billings, MT
  • About: Labcorp is a leading provider of biometric testing services, population health and comprehensive workforce wellne...
  • 3/29/2024 12:00:00 AM

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Internal Revenue Agent / Senior Revenue Agent (Examiner)-12 Month Roster AMENDED
  • Department Of The Treasury
  • Billings, MT
  • Duties WHAT IS THE LARGE BUSINESS AND INTERNATIONAL DIVISION? A description of the business units can be found at: https...
  • 3/29/2024 12:00:00 AM

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Patient Service Representative Gastroenterology
  • Intermountain Healthcare
  • Billings, MT
  • Job Description: This position is responsible for billing, follow-up, and resolving issues that delay or prevent payment...
  • 3/29/2024 12:00:00 AM

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Licensed Practical Nurse (LPN)
  • LifePoint Hospitals
  • Billings, MT
  • Description $10,000 Commitment Incentive Bonus The Rehabilitation Hospital of Montana is proud to be recognized by Newsw...
  • 3/29/2024 12:00:00 AM

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Fitness Manager - Member Experience Manager- Personal Training Manager- Shiloh
  • Anytime Fitness
  • Billings, MT
  • Why Join Our Anytime Fitness Team? Lets grow together, and become better together! We strive to be the best professional...
  • 3/29/2024 12:00:00 AM

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U-Haul Moving Center General Manager
  • U-Haul
  • Billings, MT
  • Location: 1145 W Main St, Billings, Montana 59105 United States of America U-Haul is looking for a responsible, motivate...
  • 3/25/2024 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 Member Certification Manager jobs
$79,145 to $126,427
Billings, Montana area prices
were up 3.1% from a year ago

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