Bedded Insurance Authorization Specialist

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Ensemble Health Partners

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

💼 Consultoria

🛡️ Seguros

📦 Logística

💰 Private Equity Round em 2022-03

Consulting • Insurance • Logistics

A Ensemble Health Partners é uma das principais fornecedoras de serviços de gestão do ciclo de receita (RCM) para organizações de saúde. Eles oferecem uma solução RCM completa que ajuda hospitais, sistemas de saúde e grupos de médicos afiliados a otimizar seus ciclos de receita, reduzir recusas e pagamentos incorretos, e melhorar as experiências dos pacientes usando uma combinação de gestão especializada e tecnologia avançada. A Ensemble Health Partners utiliza operadores certificados e inteligência artificial para entregar resultados consistentes, melhorar as cobranças e apoiar o crescimento futuro dos provedores de saúde. Eles são reconhecidos por suas parcerias robustas com clientes e pelo compromisso em proporcionar aumento confiável de receita e economia de custos para seus clientes.

Descrição

• Perform initial and concurrent insurance authorization securement, clinical submission, and denial prevention for hospital patients • Confirm insurance activation, coverage, effective dates, limitations, requirements, and patient liabilities • Check deductibles, coinsurance, and copayment amounts and notify patients of estimated amounts due when applicable • Verify and document insurance eligibility and benefits • Review and submit clinical documentation supporting diagnosis, treatment, services, and medical necessity • Obtain, verify, maintain, and timely renew initial and subsequent insurance authorizations • Review patient visit information and payer-specific criteria to determine authorization requirements • Ensure services are within benefit plans and eligible members use appropriate contracted providers • Review visit data and provide accurate information to payers to support authorization requests and timely follow-up • Achieve greater than 95% accuracy/quality and productivity • Work within organizational policies, processes, mission, goals, and regulatory compliance requirements

🎯 Requisitos

• Experience working with insurance companies and/or medical authorizations • Comprehensive understanding of insurance authorization requirements, contract benefits, CPT codes, and medical terminology • High level of critical thinking and problem-solving skills • Ability to retain material quickly • Positive demeanor and solid verbal and written communication skills • Professional appearance and approach • Ability to handle considerably stressful situations and multiple tasks simultaneously • Working knowledge of personal computers and standard office equipment • Ability to access online insurance eligibility and pre-certification systems • Ability to successfully complete additional job-related training • Knowledge and skills to provide age-appropriate care and assess patient data according to patients’ developmental and specific needs • High School Diploma or GED • Certified Revenue Cycle Representative (CRCR) required within 9 months of hire; company paid • Hospital experience preferred • Associate degree in Medical Assisting or Practical Nursing preferred

🏖️ Benefícios

• Remote Work • Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive Benefits, including healthcare, time off, retirement, and well-being programs • Career Advancement • Professional development investment • Quarterly and annual incentive programs • Work-life flexibility