Senior Bedded Insurance Authorization Specialist
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Job Description
Senior insurance authorization specialist securing patient approvals and preventing denials. Supporting Ensemble’s technology-enabled hospital revenue cycle management services nationwide.
Responsibilities:
- Perform initial and concurrent insurance authorization securement, clinical submission, and denial prevention for patients admitted to hospitals
- Conduct staff training and onboarding
- Perform quality audits
- Complete unbilled authorization cleanup and reduction
- Process pre-bill denials and P2P activities
- Confirm patients’ health insurance is active and covers procedures
- Verify and document insurance eligibility and benefits
- Review and submit clinical documentation supporting diagnosis, treatment, services, and medical necessity
- Obtain, verify, and maintain insurance authorizations
- Ensure initial and subsequent authorizations are obtained timely
- Review patient visit information and payer-specific criteria to determine authorization needs
- Review visit data for accurate clinical information and follow up on authorization securement
- Achieve over 95% accuracy, quality, and productivity while assisting with and monitoring Specialist assignments
- Conduct quality audits and training sessions for new hires and seasoned associates
- Perform daily unbilled authorization follow-up and reduction and pre-bill denials and P2P processing
- Assist leaders with team engagement and performance
- Provide age-appropriate care-related support in accordance with departmental policies and procedures
Requirements:
- 2 years of customer service experience
- 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 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 requirements
- High School Diploma/GED required
- CRCR required within 6 months of hire
- Must reside in and be authorized to work within the United States
Benefits:
- Comprehensive benefits package including healthcare, time off, retirement, and well-being programs
- Professional development investment
- Professional certification relevant to the associate’s field
- Tuition reimbursement
- Quarterly and annual incentive programs
- Company-paid CRCR certification within 6 months of hire
- Work-life flexibility
- Remote work
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