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)
Recently Added Member Certification Specialist jobs
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 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. - 11 Days Ago
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...
- 26 Days Ago
MSU Extension Associate Specialist and Director of Montana Seed Potato Certification Program
- Montana State University
-
Bozeman, MT
FULL_TIME
- The MSU Extension Associate Specialist and Director of Montana Seed Potato Certification Program oversees all services provided to Montana seed potato growers required to fulfill the standards of cert...
- 16 Days Ago
Implementations Analyst
- Member Driven Technologies
-
Great Falls, MT
OTHER
- SALARY RANGE$60,000 - $70,000POSITION LOCATIONThis position is eligible for a hybrid work arrangement. Currently 5 days of on-site work per month are required.POSITION PURPOSEImplementation Analysts p...
- 3 Days Ago
Client Services Support Analyst
- Member Driven Technologies
-
Great Falls, MT
OTHER
- Job Details Job Location: Great Falls Office - Great Falls, MT Position Type: Full Time Salary Range: Undisclosed DescriptionSALARY RANGE $45,000-$50,000 POSITION LOCATION This position is eligible fo...
- 19 Days Ago
Consultant
- Member Driven Technologies
-
Great Falls, MT
OTHER
- Job Details Job Location: Great Falls Office - Great Falls, MT Position Type: Full Time Salary Range: Undisclosed Travel Percentage: Occasional POSITION LOCATION This position is eligible for a hybrid...
- 2 Months Ago
Member Certification Specialist jobs at Popular Companies
Certification Specialist
- Highmark Residential, LLC
-
Raleigh, NC
- Overview: Location: Central on the Green Why Highmark Residential? Because every position is considered critical to High...
- 6/2/2024 12:00:00 AM
Inside Sales - Government Contract and Certification Specialist
- Government Services Exchange
-
Clearwater, FL
- Job Description Job Description Inside Sales – Government Contract and Certification Specialist Government Services Exch...
- 6/2/2024 12:00:00 AM
Pre-Certification Specialist
- Charter Care Health Partners
-
Providence, RI
- Summary: Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infu...
- 6/1/2024 12:00:00 AM
Long Term Temporary Position Certification Specialist
- Travaux Inc.
-
Milwaukee, WI
- Job Description Job Description CLASS SUMMARY: This position is responsible for performing technical and support tasks r...
- 6/1/2024 12:00:00 AM
Regulatory Certification Specialist 23-00850
- ESPO Corporation
-
Arlington Heights, IL
- Title: Regulatory Certification Specialist Location: Arlington Heights, IL Duration: Permanent Hire Reports to: Engineer...
- 5/31/2024 12:00:00 AM
Pre-Certification Specialist (Part Time)
- Bone and Joint Center, S.C.
-
Wausau, WI
- We are looking to add someone to our team who can work in a fast-paced environment with great customer service, has grea...
- 5/31/2024 12:00:00 AM
Licensing and Certification Specialist
- Synergy Healthcare Solutions
-
Atlanta, GA
- Administration | 55000-65000 per year | 1040 Crown Pointe Pkwy, Dunwoody, GA, USA | Salary | Synergy Healthcare Services...
- 5/29/2024 12:00:00 AM
Site Certification Specialist - Monarch Mills
- Humphrey Management
-
Columbia, MD
- Monarch Mills is looking for a site based Certification Specialist. The ideal candidate should be organized, have attent...
- 5/29/2024 12:00:00 AM
About Montana
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
$66,116 to $102,366
Most Popular Cities in Montana for Member Certification Specialist Jobs
What does a Member Certification Specialist do?
Member Certification Specialist in Providence, RI
The Legal Specialization Screening Committee and the Rules Committee of the Superior Court have approved the CBA’s certification program.
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This statewide certification requires completion of four three-hour leasing education courses.
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Member Certification Specialist in Jackson, MS
Attorneys who have attained the designation "Board Certified Workers’ Compensation Specialist" have satisfied the following requirements.
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