[Hiring] Senior Insurance Authorization Specialist @Ensemble Health Partners

Role Description

The Bedded Insurance Authorization Senior 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 also responsible for conducting staff training, onboarding, quality audits, unbilled clean-up and reduction, and pre-bill denials processing. While performing these functions, they are required to maintain the mission and goals of Ensemble Health Partners and all regulatory compliance requirements.

• 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.
• 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 appropriately secure authorization and provide clinical to support medical necessity.
  • Responsible for reviewing visit data to ensure appropriate and accurate clinical information is provided to the payor to support the authorization request and follow-up timely for authorization securement.
• Achieve >95% accuracy/quality and productivity while assisting with and monitoring Specialist assignments.
• Conduct quality audits and training sessions for new hires and seasoned associates based on departmental expectations and metrics.
• Prevent delayed claims process through daily unbilled authorization follow-up and reduction and pre-bill denials & P2P processing.
• Assist leaders with team engagement while fostering positivity for driving performance.
• Demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
• Demonstrate knowledge of the principles of growth and development of the life span and possess the ability to assess data reflective of the patient's status and interpret 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.

Qualifications

• 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, solid verbal and written communication skills.
• Professional in both appearance and approach.
• Ability to handle considerably stressful situations and multiple tasks simultaneously.
• Working knowledge of personal computers and other standard office equipment.
• Ability to access online insurance eligibility and pre-certification systems.

Requirements

• High School Diploma/GED Required.
• Preferred Education: 2 Year/Associates Degree in Medical Assisting or Practical Nursing.
• Certification: CRCR Required within 6 months of hire (Company Paid).

Benefits

• 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.
• Investment in professional development, including earning a professional certification relevant to the field and tuition reimbursement.
• Quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.