Bedded Insurance Authorization Specialist

ensemblehp; United States; Remote; USD 35,000 - 39,000; Full time

Benefits offered by this job

Remote Work

Bonus Incentives

Paid Certifications

Tuition Reimbursement

Comprehensive Benefits

Career Advancement

Job summary

Ensemble Health Partners is seeking a Bedded Insurance Authorization Specialist to secure initial and concurrent insurance authorizations for hospital admissions, ensuring medical necessity and timely submissions.

You will verify coverage, determine benefits, deductibles, coinsurance, and patient liabilities while minimizing denials and meeting regulatory requirements across the organization.

Qualifications

• Experience working with insurance companies and/or medical authorizations.
• Comprehensive understanding of insurance authorization requirements, contract benefits, CPT codes and medical terminology.
• Ability to use critical thinking and problem-solving to retain material quickly.
• Positive demeanor with strong verbal and written communication skills; professional in appearance and approach.
• Ability to handle stressful situations and manage multiple tasks simultaneously.
• Working knowledge of personal computers and common office equipment; access to online eligibility and pre-certification systems.
• Willingness to complete additional job-related training when offered.

Responsibilities

• Verify that patient health insurance is active and covers the procedure.
• Determine benefits, deductibles, coinsurance, and patient liabilities; notify patient when applicable.
• Verify coverage details and expected amounts prior to services.
• Ensure required authorizations are obtained and maintained in a timely manner; reduce denials.
• Review patient visit data to support medical necessity and payor criteria for authorization.
• Ensure services are within benefit plans and contracted providers are used.
• Aim for accuracy/quality and productivity above 95%.

Skills

Insurance experience

Medical authorizations

Critical thinking

Communication skills

Multi-tasking

Computer literacy

Training willingness

Tools

Online insurance eligibility systems

Pre-certification platforms

EHR systems

Job description

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:

CAREER OPPORTUNITY OFFERING:

• 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 need