Specialist, Insurance

Lifepoint Health•Las Cruces, NM

About The Position

Memorial Medical Center Job Title: Insurance Specialist Job Type: Full Time Reports to: Patient Access Supervisor FLSA: Non-exempt 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. How you'll contribute The Insurance Specialist is responsible for the verification/documentation of insurance benefits, securing pre-certification/referral numbers and estimating/collecting patient liabilities on all outpatient scheduled procedures.. Essential Functions 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 estimate 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 Nonessential Functions Perform other duties as assigned Minimum Qualifications 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 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 and part-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. Memorial Medical Center is an Equal Opportunity Employer. MMC is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment

Requirements

High school diploma or equivalent is required.
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

Nice To Haves

Two years of college or medical office specialist education - Preferred

Responsibilities

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 estimate 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
Perform other duties as assigned

Benefits

Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
Ongoing learning and career advancement opportunities.

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