Senior Insurance Authorization Specialist - Infusion

Ensemble Health Partners; Blue Ash (OH); Remote; USD 25,000 - 33,000; Full time

Benefits offered by this job

Best in KLAS Awards

Remote work option

Tuition reimbursement

Professional development

Job summary

Ensemble Health Partners is seeking a Senior Insurance Authorization Specialist to support authorization/verification for patients. This remote role involves collaborating with physicians and insurers to secure approvals while upholding regulatory compliance and quality targets.

The position requires 1–3 years in a similar role, familiarity with revenue cycle processes for medical services, and a CRCR certification within 9 months of hire. Travel may be required for onsite client engagements.

Qualifications

• Minimum education: High School Diploma or GED.
• CRCR certification required within 9 months of hire.

Responsibilities

• Select the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.
• Serve as liaison between ordering physician and insurance company to ensure all requirements are identified and communicated.
• Assist the department supervisor with training, mentoring of new hires, and escalation handling.
• Perform other duties as assigned.

Education

High School Diploma/GED

CRCR Certification

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:The Senior Insurance Authorization Specialist is responsible for supporting the Insurance Authorization Specialist I and Insurance Verification Specialists I while performing insurance authorization and verification for all patients scheduled for services at Ensemble Health Partners. They are responsible for performing these functions while meeting the mission of Ensemble Health Partners and all regulatory compliance requirements. The Senior Insurance Authorization Specialist will work within the policies and processes as they are being performed across the entire organization. They'll support the Department's Supervisor with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified.This position pays between $18.65 - $23.50 based on experienceJob Responsibilities:The Senior Insurance Authorization Specialist will support the Insurance Authorization I staff in their responsibility for selecting accurate medical records for patient safety, obtaining and validating demographic and insurance information, working with insurance companies and/or physician offices to complete insurance authorization requirements to secure payment, and ensure active/eligible coverage.Assist the supervisor of the department with escalated issues, tracking system and process issues as well as assisting in the training and mentoring of new hires. Among the expectations of this role the Senior Insurance Authorization Specialist will assist the Insurance Authorization Specialists I and Insurance Verification Specialists I in achieving: >95% accuracy/quality while handling accounts, as measured by account audits >95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards. Assist the supervisor of the department with escalated issues, tracking system and process issues as well as assisting in the training and mentoring of new hires.Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.Performs other duties as assigned.Experience We Love:1-3 years of experience in a similar roleExperience with authorization or revenue cycle processes for physician/hospital administered medications, injections, infusions, or genetic testing is preferredExperience with infusion therapies and lifecycle management of the infusion authorization processExperience with oncology and specialty infusion therapies, treatment plans, and applying payor specific rules/policiesMust be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiencesThis is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs requireMinimum Education:High School Diploma/GED RequiredPreferred:2 Year/ Associates Degree2 Year/ Associates DegreeCertifications:Certified Revenue Cycle Representative (CRCR) required within 9 months of hire -Company PaidJoin an award-winning companyFive-time winner of “Best in KLAS” 2020-2022, 2024-2025Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-202422 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023Energage Top Workplaces USA 2022-2024Fortune Media Best Workplaces in Healthcare 2024Monster Top Workplace for Remote Work 2024Great Place to Work certified 2023-2024InnovationWork-Life FlexibilityLeadershipPurpose + ValuesBottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: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. Our culture is rooted in collaboration, growth, and innovation.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] 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. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.Employment Disclaimers – Ensemble