Insurance Verification & Pre-Certification Specialist

Lifepoint Health, Inc.; Las Cruces (NM); In loco; USD 42.000 - 56.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive Benefits

Paid Time Off

Tuition assistance

401(k) retirement plan

Disability & life insurance

Descrizione del lavoro

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.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

Insurance verification

Pre-certification

Payer communications

Registration functions

Critical thinking

Multitasking

Stress management

Managed care

Formazione

High school diploma

Two years college

Medical office training

Strumenti

Insurance eligibility tools

Payer websites

Pre-certification systems

Descrizione del lavoro

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.