Insurance Specialist

Lifepoint Health • Las Cruces, NM

12d

About The Position

Memorial Medical Center, part of Lifepoint Health, is hiring an Insurance Specialist to support outpatient scheduled procedures. The role verifies insurance coverage and benefits, obtains required pre-certifications and referral numbers, and creates and explains patient liability estimates. It involves frequent communication with insurance payers, patients, physician offices, centralized scheduling, and hospital departments to ensure insurance requirements and relevant clinical documentation are addressed before appointments. The specialist also performs registration functions as needed.

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 and take appropriate action in a stressful environment.
• Ability to function appropriately 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, secure pre-certification or referral numbers, and estimate and collect patient liabilities for outpatient scheduled procedures.
• Obtain and document managed-care pre-certifications for scheduled surgeries and procedures in advance of 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 requirements.
• 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 outpatient scheduled procedures.
• Maintain current knowledge of outpatient imaging policies and procedures.
• Verify active insurance coverage and obtain benefits using insurance eligibility tools, payer websites, and payer phone systems.
• Communicate with the Benefits and Notification Specialist when a patient has no verifiable insurance benefits to cover a scheduled procedure.
• Work 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.
• Perform 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.
• 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