Senior Hospital Insurance Authorization Specialist

Ensemble Health Partners; Ohio; Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Healthcare

Time off

Retirement benefits

Well-being programs

Job summary

Ensemble Health Partners seeks a Bedded Insurance Authorization Senior Specialist to manage initial and concurrent insurance authorization, clinical submission, and denial prevention for all hospital patients. You will conduct staff training, onboarding, and quality audits, perform unbilled cleanup, and participate in Pre-Bill Denials processing while upholding Ensemble's mission and regulatory compliance.

This role requires strong problem solving, effective communication, and the ability to

Qualifications

• 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.

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.
• 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.

Skills

Customer service

Insurance authorizations

CPT codes

Medical terminology

Critical thinking

Verbal and written communication

Stress management

Education

High School Diploma/GED

Associates degree (preferred) Medical Assisting or Practical Nursing Certification

Job description

Ensemble Health Partners seeks a Bedded Insurance Authorization Senior Specialist to manage initial and concurrent insurance authorization, clinical submission, and denial prevention for all hospital patients. You will conduct staff training, onboarding, and quality audits, perform unbilled cleanup, and participate in Pre-Bill Denials processing while upholding Ensemble's mission and regulatory compliance.

This role requires strong problem solving, effective communication, and the ability to