Bedded Insurance Authorization Specialist

Ensemble Health Partners; United States; Remoto; USD 36.000 - 39.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work options

Tuition reimbursement

Certifications paid

Comprehensive benefits

Career advancement

Descrizione del lavoro

Ensemble Health Partners is seeking a Bedded Insurance Authorization Specialist to perform initial and concurrent insurance authorization securement, clinical submission, and denial prevention for hospital patients. The role emphasizes accuracy (>95%), timely authorizations, and compliance across clients.

Remote work options, certifications, and tuition reimbursement are offered. The position requires experience with insurance companies, CPT codes, and medical terminology, plus strong

Competenze

• Experience with insurance companies and/or medical authorizations.
• Understanding of insurance authorization requirements, CPT codes, and medical terminology.
• Strong problem-solving, critical thinking, and written/verbal communication skills.
• Ability to handle stressful situations and multitask effectively.

Mansioni

• Verify patient insurance eligibility and coverage for planned procedures.
• Obtain and maintain required insurance authorizations in a timely manner.
• Review visit data to support authorization requests and payer requirements.
• Reduce and prevent authorization denials and ensure appropriate provider utilization.
• Support documentation and communication with payers and care teams.

Formazione

High School Diploma or GED

CRCR certification within 9 months of hire

Descrizione del lavoro

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity

Remote Work Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement

The position pays between $17.00 - $18.65/hr based on experience.

The Bedded Insurance Authorization Specialist is responsible for performing initial and concurrent insurance authorization securement, clinical submission and denial prevention for all patients admitted to the hospital for clients. They are responsible for performing these functions while meeting the mission and goals of Ensemble Health Partners and all regulatory compliance requirements. The Bedded Insurance Authorization Specialist will work within the policies and processes as they are being performed across the entire organization.

• Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; may be completed multiple times during, and after a patient’s visit/stay.
• Confirm what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities for the type of service(s) provided.
• Check benefits to determine deductible, coinsurance, and copayment amounts due. If applicable; use procedure estimate process/program to notify the patient in advance of the amount due.
• Ensure payer requirements including the following are met: Verify and document insurance eligibility; confirm and document benefits. Review and submission of clinical documentation to ensure the treatment/services are appropriate for the diagnosis as determined.
• Obtain and verify that insurance authorizations are obtained and maintained on designated patients.
• Ensure that initial and all subsequent authorizations are obtained in a timely manner.
• Work to reduce and eliminate authorization denials.
• Review and analyze patient visit information to determine whether authorization is needed and understand payor specific criteria to appropriate secure authorization and provide clinical to support medical necessity.
• Ensure that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized.
• Responsible for reviewing visit data to ensure appropriate and accurate information is provided to the payor to support the authorization request and follow-up timely.

Among the expectations of this role, the Specialist will achieve: >95% accuracy/quality and productivity.

Qualifications

Must have experience working with insurance companies and/or medical authorizations. Must have comprehensive understanding of insurance authorization requirements, contract benefits, CPT codes and medical terminology. Work requires a high level of critical thinking and problem-solving skills and the ability to retain material quickly. Must demonstrate a positive demeanor, solid verbal and written communication skills, and be professional in both appearance and approach. Must be able to handle considerably stressful situations and multiple tasks simultaneously. Must be able to demonstrate a working knowledge of personal computers and other standard office equipment. Work requires the ability to access online insurance eligibility and pre-certification systems. Must be able to successfully complete additional job-related training when offered. Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit. Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures. Must have experience working with insurance companies and/or medical authorizations. Must have comprehensive understanding of insurance authorization requirements, contract benefits, CPT codes and medical terminology. Work requires a high level of critical thinking and problem-solving skills and the ability to retain material quickly. Must demonstrate a positive demeanor, solid verbal and written communication skills, and be professional in both appearance and approach. Must be able to handle considerably stressful situations and multiple tasks simultaneously. Must be able to demonstrate a working knowledge of personal computers and other standard office equipment. Work requires the ability to access online insurance eligibility and pre-certification systems. Must be able to successfully complete additional job-related training when offered.

Minimum Years and Type of Experience

Hospital experience preferred

Required Minimum Education

High School Diploma or GED Certified Revenue Cycle Representative (CRCR) required within 9 months of hire

Company Paid Preferred Education

2 Year/ Associates Degree

Specialty/Major

Medical Assisting or Practical Nursing

Join an award-winning company Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 Innovation Work-Life Flexibility Leadership Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive.

Benefits & Perks

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer.

It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws.

Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States.

Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.

If you require accommodation in the application process, please contact [e-mail].

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position.

Ensemble is dedicated to providing our clients with experienced healthcare finance and revenue cycle professionals. We believe that our core values of trust, integrity, loyalty and service married with the belief that our work is worthwhile helps us build and sustain sincere relationships with our associates and clients. If you are a passionate, dedicated and experienced revenue cycle, consulting or finance professional and seek career and personal growth, we would love to hear from you. We believe we foster an environment where talented individuals can excel and shine. Our team believes that people are the most important part of our success and that when we take care of our people, they pay it forward by providing our clients with excellent results and world-class service.