Authorization Specialist (Full-time/Cody) Job

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- and part-time employees (minimum of 20 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. Click here for more information or download the Employee Benefits Guide.

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. Click here to learn more!

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

Authorization Specialist (Full-time/Cody)
CODY CLINIC - 6760 (BILLINGS CLINIC CODY CLINIC)
req11573

Shift: Day
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 0.75 = 60 hours every two weeks (Non-Exempt)
Starting Wage DOE: $0.00 - 0.00

Responsible for performing the 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 reimbursement questions and avoid insurance delays. Tracks, documents, and monitors authorizations. Implements check and balance systems to ensure timely compliance.

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 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.
* 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 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.
* Makes referrals as needed to ensure patient's needs are met and precertification/authorization is obtained.
* Reports denials and/or delays in the authorization process to the health care team and/or the patient. Provides information to the patient on the appropriate appeal process for denials as needed.
* Responsible for authorization of pre-scheduled elective inpatient and/or outpatient procedures, diagnostic testing and/or planned medical admissions.
* Reviews CPT-4 codes against Medicare and other payer specific inpatient only lists, if applicable, to assigned departments. Maintains updated list. Ensures correct patient status when pre-certifying. Validates CPT and diagnosis codes match documented physician treatment plan.
* Reviews CPT-4 codes against Medicaid listings of required precertification and/or authorizations. Ensures Passport pre-certification process is met.
* Participates in interdepartmental meetings to coordinate efforts, work through processes, and foster communication.
* Responsible for precertification for Billings Clinic campus and regional outreach services
* Reviews daily hospital work list to determine if patient's payer requires authorization/ notification.
* Understands insurance/payer policy language, benefits and authorization requirements upon admission, for concurrent review, and for discharge.
* Conducts concurrent authorization with third party payers during the patient's stay.
* Conducts follow-up calls, as necessary, to third party payers to complete authorization process validating that all days are authorized.
* Performs all other duties as assigned or as needed to meet the needs of the department/organization.

Minimum Qualifications

Education

* High school graduate or GED 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 being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, marital status, national origin, age, genetic information, military status, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.