Senior Insurance Authorization Specialist - Infusion

Thank you for considering a career at Ensemble! 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 Senior Insurance Authorization Specialist is responsible for supporting the Insurance Authorization Specialist I and Insurance Verification Specialists I while performing insurance authorization and verification for all patients scheduled for services at Ensemble Health Partners. They are responsible for performing these functions while meeting the mission of Ensemble Health Partners and all regulatory compliance requirements. The Senior Insurance Authorization Specialist will work within the policies and processes as they are being performed across the entire organization.

They'll support the Department's Supervisor with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified. This position pays between $18.65 - $23.50 based on experience.

The Senior Insurance Authorization Specialist will support the Insurance Authorization I staff in their responsibility for selecting accurate medical records for patient safety, obtaining and validating demographic and insurance information, working with insurance companies and/or physician offices to complete insurance authorization requirements to secure payment, and ensure active/eligible coverage. Assist the supervisor of the department with escalated issues, tracking system and process issues as well as assisting in the training and mentoring of new hires.

Among the expectations of this role the Senior Insurance Authorization Specialist will assist the Insurance Authorization Specialists I and Insurance Verification Specialists I in achieving: >95% accuracy/quality while handling accounts, as measured by account audits >95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards.

Assist the supervisor of the department with escalated issues, tracking system and process issues as well as assisting in the training and mentoring of new hires. Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.

Performs other duties as assigned.

• 1-3 years of experience in a similar role
• Experience with authorization or revenue cycle processes for physician/hospital administered medications, injections, infusions, or genetic testing is preferred
• Experience with infusion therapies and lifecycle management of the infusion authorization process
• Experience with oncology and specialty infusion therapies, treatment plans, and applying payor specific rules/policies
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences