Virtual Insurance Professional

About Ensemble Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. 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. Customer Obsession: Remote Work Bonus Incentives Tuition Reimbursement Role Overview The Bedded Insurance Authorization Specialist is responsible for performing initial and concurrent insurance authorization securement, clinical submission and denial prevention for all patients admitted to the hospital for clients. They are responsible for performing these functions while meeting the mission and goals of Ensemble Health Partners and all regulatory compliance requirements. The Bedded Insurance Authorization Specialist will work within the policies and processes as they are being performed across the entire organization. Responsibilities Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; Confirm what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities for the type of service(s) provided. Verify and document insurance eligibility; confirm and document benefits. Obtain and verify that insurance authorizations are obtained and maintained on designated patients. 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 information is provided to the payor to support the authorization request and follow-up timely. 95% accuracy/quality and productivity. 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 be able to demonstrate a working knowledge of personal computers and other standard office equipment. Work requires the ability to access online insurance eligibility and pre-certification systems. Must be able to successfully complete additional job-related training when offered. Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit. Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures. 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 be able to demonstrate a working knowledge of personal computers and other standard office equipment. Work requires the ability to access online insurance eligibility and pre-certification systems. Must be able to successfully complete additional job-related training when offered. Hospital experience preferred Qualifications High School Diploma or GED Specialty/Major: Medical Assisting or Practical Nursing Awards and Recognition Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Monster Top Workplace for Remote Work 2024 Benefits 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. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. Equality, Diversity, and Inclusion 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. 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. 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 equity; #J-18808-Ljbffr Ensemble Health Partners