Bedded Insurance Authorization Specialist

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. The specialist performs these functions while meeting 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.
• 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 submit 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 and 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 secure authorization and provide clinical evidence to support medical necessity.
• Ensure that services provided to eligible members are within the benefit plan and appropriate contracted providers are being utilized.
• Review visit data to ensure appropriate and accurate information is provided to the payor to support the authorization request and follow‑up timely.

• Must have 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 and ability to retain material quickly.
• Positive demeanor, solid verbal and written communication skills, professional appearance and approach.
• Ability to handle 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.
• Successfully complete additional job‑related training when offered.
• Minimum education:
  
  High School Diploma or GED. Certified Revenue Cycle Representative (CRCR) required within 9 months of hire. Hospital experience preferred.
• Preferred: 2‑year associate degree in Medical Assisting or Practical Nursing.

Competitive hourly rate ($17.00 - $18.65/hr), remote work options, bonus incentives, paid certifications, tuition reimbursement, comprehensive benefits (healthcare, time off, retirement, wellbeing programs).

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 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