Insurance Specialist

Lifepoint Health Careers; Las Cruces (NM); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Comprehensive Benefits

Paid Time Off

Tuition assistance

401(k) retirement plan

Disability & life insurance

Job summary

Memorial Medical Center, part of Lifepoint Health, is seeking an Insurance Specialist in Las Cruces, NM. The role focuses on verifying insurance benefits, obtaining pre-certifications, and communicating with payers to ensure accurate patient billing.

You will work closely with physicians and scheduling teams to secure timely pre-certifications, document benefits, and explain patient liabilities. A high school diploma is required, with college coursework preferred.

Qualifications

• High school diploma or equivalent is required.
• Two years of college or medical office specialist education - Preferred.
• One year experience with obtaining and verifying pre-certifications with various insurance companies Required.
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.
• Must be able to function appropriately in a multi-task setting.
• Working knowledge of managed care and third-party payors.

Responsibilities

• Verifies and documents insurance benefits, secures pre-certification/referral numbers and estimates/collects patient liabilities on all outpatient scheduled procedures.
• Ensures pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on time and documented in advance of appointment.
• Notifies physician offices and centralized scheduling if pre-cert is not obtained in time for appointments.
• Heavy phone and payer website contact per payer pre-cert and verification regulations.
• Communicates with insurance payers regarding CPT code discrepancies or changes due to radiologist discretion.
• Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures.
• Maintains current knowledge of outpatient imaging policies and procedures.
• Verifies active insurance coverage and obtains benefits using eligibility tools, payer websites and phone systems.
• Communicates with Benefits and Notification Specialist for patients with no verifiable coverage.
• Works with physician offices and hospital departments to obtain/forward clinical information as needed.
• Generates and explains patient liability estimates for scheduled/add-on procedures.
• Contacts patients/physician offices when insurance information is invalid or terminated.
• Provides registration functions, as needed.

Skills

Insurance verification

Pre-certification

Payer communications

Registration functions

Critical thinking

Multitasking

Stress management

Managed care

Education

High school diploma

Two years college

Medical office training

Tools

Insurance eligibility tools

Payer websites

Pre-certification systems

Job description

Your experience matters

Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As an Insurance Specialist, joining our team, you're embracing a vital mission dedicated to making communities healthier®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How you’ll contribute

An Insurance Specialist who excels in this role:

• Verifies and documents insurance benefits, secures pre-certification/referral numbers and estimates/collects patient liabilities on all outpatient scheduled procedures.


• Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointment


• Notifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointments


• Heavy phone and payer website contact in accordance with payer pre-cert and verification regulations


• Communicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretion


• Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures.


• Maintains current knowledge of outpatient imaging policies and procedures


• Verifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systems


• Communicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedure.


• Works closely with physician offices and departments of the hospital when obtaining clinical information, providing them with necessary information or forwarding relevant documents to them.


• Creates and explains patient liability estimates for all scheduled and add-on procedures.


• Contacts patient or physician offices when insurance information invalid or termed for all scheduled procedures.


• Provides registration functions, as needed.

What we're looking for

Education

• High school diploma or equivalent is required.


• Two years of college or medical office specialist education - Preferred.

Skills & Experience

• One year experience with obtaining and verifying pre-certifications with various insurance companies Required.


• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.


• Must be able to work in a stressful environment and take appropriate action.


• Must be able to function appropriately in a multi-task setting.


• Working knowledge of managed care and third-party payors.

Schedule

Full-time

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

• Comprehensive Benefits:Multiple levels of medical, dental and vision coverage for full-time andpart-time employees.


• Financial Protection & PTO:Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.


• Financial & Career Growth:Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.


• Employee Well-being:Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).


• Professional Development:Ongoing learning and career advancement opportunities.

More about Memorial Medical Center

Memorial Medical Center is a 199-bed acute medical/surgical teaching hospital located in Las Cruces, NM, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters.

EEOC Statement

Memorial Medical Centeris an Equal Opportunity Employer.Memorial Medical Centeris committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.