Senior Bedded Insurance Authorization Specialist

ensemblehp; United States; Remote; USD 55.000 - 76.000; Vollzeit

Zusammenfassung

Ensemble Health Partners is seeking a Bedded Insurance Authorization Senior Specialist to manage initial and concurrent insurance authorization, clinical submission, and denial prevention for hospital-admitted patients. You will also lead staff training, onboarding, audits, and unbilled cleanup while ensuring compliance with regulatory requirements.

You will verify eligibility, benefits, and obtain timely authorizations, aiming for high accuracy and productivity.

Qualifikationen

• Minimum 2 years of customer service experience.
• Experience with insurance companies and/or medical authorizations.
• Understanding of CPT codes and medical terminology.

Aufgaben

• Perform initial and concurrent insurance authorization for admitted patients.
• Submit clinical information to ensure appropriate authorization and medical necessity.
• Obtain and maintain patient-specific authorizations in a timely manner.
• Conduct staff training, onboarding, and quality audits.
• Reduce pre-bill denials and unbilled authorization follow-up.
• Support leadership with team engagement and performance metrics.

Ausbildung

High School Diploma/GED

CRCR Certification

Jobbeschreibung

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:

The Bedded Insurance Authorization Senior 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 also responsible for conducting staff training, and onboarding, quality audits, Unbilled clean-up and reduction and Pre-Bill Denials processing. While performing these functions they are required to maintain the mission and goals of Ensemble Health Partners and all regulatory compliance requirements.

Job Responsibilities:

• 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.
• 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.
• Responsible for reviewing visit data to ensure appropriate and accurate clinical information is provided to the payor to support the authorization request and follow-up timely for authorization securement.
• Among the expectations of this role, the Senior Specialist will achieve: >95% accuracy/quality and productivity while assisting with and monitoring Specialist assignments.
• Conducts quality audits and training sessions for new hires and seasoned associates based on departmental expectation and metrics.
• Prevention of delayed claims process through daily Unbilled authorization follow-up and reduction and Pre-Bill Denials & P2P processing.
• Assists leaders with team engagement while fostering positivity for driving performance.
• 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.

Experience:

• 2 years of customer service experience
• 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

Required Education:

High School Diploma/GED Required

Preferred Education:

2 Year/ Associates Degree Medical Assisting or Practical Nursing

Certification:

CRCR Required within 6 months of hire (Company Paid)

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