Bedded Insurance Authorization Specialist

Bedded Insurance Authorization Specialist

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!

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.

- Confirm that a patient's health insurance(s) is active and covers the patient's procedure; may be completed multiple times during, and after a patient's visit/stay.

- 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.

- Check benefits to determine deductible, coinsurance, and copayment amounts due. If applicable; use procedure estimate process/program to notify the patient in advance of the amount due.

- Ensure payer requirements including the following are met:

• Verify and document insurance eligibility; confirm and document benefits.
• Review and submission of clinical documentation to ensure the treatment/services are appropriate for the diagnosis as determined.
• Obtain and verify that insurance authorizations are obtained and maintained on designated patients.
• Ensure that initial and all subsequent authorizations are obtained in a timely manner.
• Work to reduce and eliminate authorization denials.

- 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.

- Ensure that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized.

- 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. Among the expectations of this role, the Specialist will achieve: >95% accuracy/quality and productivity.

Qualifications :

• 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 demonstrate a positive demeanor, solid verbal and written communication skills, and be professional in both appearance and approach.
• Must be able to handle considerably stressful situations and multiple tasks simultaneously.
• 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.

Minimum Years and Type of Experience:

• Hospital experience preferred

Required Minimum Education:

• High School Diploma or GED
• Certified Revenue Cycle Representative (CRCR) required within 9 months of hire -Company Paid

Preferred Education:

• 2 Year/ Associates Degree
• Specialty/Major: Medical Assisting or Practical Nursing

Join an award-winning company

Five-time winner of "Best in KLAS" 2020-2022, 2024-2025

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

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom 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.

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 View email address on click.appcast.io.

This 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.