Insurance Specialist

Lifepoint Health • Las Cruces, NM

9d

About The Position

Memorial Medical Center, part of Lifepoint Health, is seeking an Insurance Specialist to support outpatient scheduled procedures. The role verifies insurance coverage and benefits, obtains and documents required pre-certifications and referral numbers, and prepares and explains patient liability estimates. It involves frequent contact with insurance payers by phone and through payer websites, along with coordination with physician offices, hospital departments, and other specialists. Registration functions may also be performed as needed.

The position requires a high school diploma or equivalent and at least one year of experience obtaining and verifying pre-certifications with insurance companies. Candidates should have working knowledge of managed care and third-party payers, be able to think critically and make decisive judgments, and work with minimal supervision in a stressful, multitasking environment.

Requirements

• High school diploma or equivalent required.
• At least one year of experience obtaining and verifying pre-certifications with various insurance companies required.
• Critical-thinking skills and decisive judgment.
• Ability to work with minimal supervision.
• Ability to work in a stressful environment and take appropriate action.
• Ability to function in a multitasking setting.
• Working knowledge of managed care and third-party payers.

Nice To Haves

• Two years of college or medical office specialist education preferred.

Responsibilities

• Verify and document insurance benefits, obtain pre-certification or referral numbers, and estimate and collect patient liabilities for scheduled outpatient procedures.
• Obtain required managed-care pre-certifications for scheduled surgeries and procedures in a timely manner and document them before appointments.
• Notify physician offices and centralized scheduling when pre-certification has not been obtained in time for an appointment.
• Contact payers by phone and through payer websites in accordance with payer pre-certification and verification regulations.
• Communicate with insurance payers about CPT code discrepancies or changes made at the radiologist’s discretion.
• Perform insurance verification, eligibility checks, and pre-certification for scheduled outpatient procedures.
• Maintain current knowledge of outpatient imaging policies and procedures.
• Verify active insurance coverage and obtain benefits using eligibility tools, payer websites, and payer phone systems.
• Notify the Benefits and Notification Specialist when a patient has no verifiable insurance benefits to cover a scheduled procedure.
• Coordinate with physician offices and hospital departments to obtain clinical information, provide necessary information, and forward relevant documents.
• Create and explain patient liability estimates for scheduled and add-on procedures.
• Contact patients or physician offices when insurance information is invalid or terminated for scheduled procedures.
• Provide registration functions as needed.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED