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Innovation in Revenue Cycle Management
Bedded Insurance Authorization Specialist
Location
United States
Posted
103 days ago
Salary
$17 - $18 / hour
Seniority
Senior
Job Description
Bedded Insurance Authorization Specialist
Ensemble Health Partners
• Responsible for performing initial and concurrent insurance authorization securement, clinical submission and denial prevention for all patients admitted to the hospital for clients. • 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. • Ensure payer requirements including 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.
Job Requirements
- 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.
Benefits
- Remote Work
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits
- Career Advancement
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