Bedded Insurance Authorization Specialist

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Private Equity Round on 2022-03

Consulting • Insurance • Logistics

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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