Bedded Insurance Authorization Specialist

📋 Description

• • As a Bedded Insurance Authorization Specialist at Ensemble Health Partners, you will play a critical role in ensuring that patients receive the necessary approvals for their hospital admissions and treatments, directly contributing to the financial health of our client hospitals and the well-being of patients.
• • Your primary responsibility will be to meticulously perform initial and concurrent insurance authorization securement for all admitted patients. This involves a proactive approach to ensure that treatments and services are pre-approved by the patient's insurance provider, thereby preventing potential claim denials and financial burdens.
• • You will be tasked with confirming the active status of a patient’s health insurance(s) and verifying that it covers the specific procedure or treatment planned. This verification process may need to be conducted multiple times throughout a patient’s visit or stay to ensure continuous coverage.
• • A key aspect of your role will be to thoroughly investigate and document the benefits covered by a patient’s insurance policy. This includes understanding the exact coverage details, the effective dates of the policy, any limitations or specific requirements for coverage, and importantly, the patient's financial liabilities for the services they will receive.
• • You will utilize procedure estimate processes to accurately calculate and communicate deductible, coinsurance, and copayment amounts to patients in advance, fostering transparency and managing patient expectations regarding their financial responsibilities.
• • Ensuring compliance with all payer requirements is paramount. This involves meticulously verifying and documenting insurance eligibility, confirming and documenting benefits, and ensuring that all necessary clinical documentation is reviewed and submitted to support the appropriateness of the treatment or services for the patient's diagnosis.
• • A significant part of your responsibility will be to obtain and maintain insurance authorizations for designated patients. This requires a keen eye for detail and a systematic approach to ensure that initial and all subsequent authorizations are secured in a timely manner, preventing any gaps in coverage.
• • You will actively work to reduce and eliminate authorization denials by identifying potential issues early, addressing them proactively, and collaborating with clinical and administrative teams to ensure all requirements are met.
• • The role demands a thorough review and analysis of patient visit information to determine the necessity of an authorization and to understand payor-specific criteria for obtaining it. You will provide clinical support to justify medical necessity, ensuring that services align with the patient's plan benefits and that contracted providers are utilized where applicable.
• • Accuracy and efficiency are critical. You will be responsible for ensuring that visit data is reviewed for accuracy and that appropriate information is provided to the payor to support authorization requests. Timely follow-up on all requests is essential to maintain workflow and patient care continuity.
• • You are expected to achieve and maintain a high standard of performance, with targets typically exceeding 95% accuracy/quality and productivity, reflecting the critical nature of this role in the revenue cycle.
• • This position offers a fully remote work arrangement, providing flexibility and the ability to work from anywhere nationwide.
• • You will be part of a dynamic team within a leading provider of technology-enabled revenue cycle management solutions for health systems, contributing to a mission of keeping communities healthy by keeping hospitals healthy.
• • Ensemble Health Partners fosters a culture of Customer Obsession, Embracing New Ideas, and Striving for Excellence, encouraging associates to challenge the status quo and make a meaningful difference.
• • Your contributions will directly impact patient care by ensuring seamless administrative processes, allowing healthcare providers to focus on delivering exceptional medical services.
• • You will have opportunities for professional growth, including paid certifications and tuition reimbursement, supporting your career advancement within the organization.
• • This role is integral to the financial integrity of healthcare providers, requiring a strong understanding of insurance processes, medical terminology, and regulatory compliance.
• • You will work with various online eligibility and pre-certification systems, requiring a solid understanding of personal computers and standard office equipment.
• • The ability to handle stressful situations and manage multiple tasks simultaneously is crucial for success in this fast-paced environment.
• • You will be expected to demonstrate a positive demeanor, strong communication skills, and a professional approach in all interactions.
• • This role requires a high level of critical thinking and problem-solving skills, with the ability to quickly learn and retain new information.
• • You will be responsible for ensuring that services provided to eligible members are within their benefit plan and that appropriate contracted providers are being utilized, optimizing patient care and cost-effectiveness.