Senior Bedded Insurance Authorization Specialist

Ensemble Health Partners • Work at Home - Ohio - Other, OH

9d • $19 - $25 • Remote

About The Position

The Senior Bedded Insurance Authorization Specialist performs initial and concurrent insurance authorization securement, clinical submission, and denial prevention for patients admitted to client hospitals. The role also includes staff training and onboarding, quality audits, unbilled authorization follow-up and reduction, and pre-bill denial processing. The specialist is expected to maintain Ensemble Health Partners’ mission and goals and comply with applicable regulatory requirements.

The position involves verifying insurance eligibility and benefits, reviewing and submitting clinical documentation, obtaining and maintaining authorizations, and following up with payers to secure authorization promptly. The specialist reviews visit information and payer criteria to determine authorization needs and provide clinical information supporting medical necessity. Senior-level duties include assisting with and monitoring specialist assignments, conducting audits and training, supporting team engagement, and processing pre-bill denials and peer-to-peer (P2P) work. The role is remote and is limited to individuals residing and authorized to work in the United States.

Requirements

• At least 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.
• Strong critical-thinking and problem-solving skills, with the ability to retain material quickly.
• Positive demeanor and solid verbal and written communication skills; professional in appearance and approach.
• Ability to handle stressful situations and multiple tasks simultaneously.
• Working knowledge of personal computers and standard office equipment.
• Ability to access online insurance eligibility and precertification systems.
• High school diploma or GED.
• CRCR certification required within 6 months of hire; company paid.

Nice To Haves

• Associate degree in Medical Assisting or Practical Nursing.

Responsibilities

• Confirm that patients’ insurance coverage is active and covers the procedure, including checks during and after a patient’s visit or stay.
• Verify and document insurance eligibility and benefits according to payer requirements.
• Review and submit clinical documentation to support the appropriateness of treatment and services for the diagnosis.
• Obtain, verify, and maintain insurance authorizations for designated patients.
• Secure initial and subsequent authorizations in a timely manner.
• Work to reduce and eliminate authorization denials.
• Review patient visit information and payer-specific criteria to determine authorization requirements and support medical necessity.
• Ensure accurate clinical information is provided to payers and follow up promptly to secure authorizations.
• Assist with and monitor specialist assignments while meeting accuracy, quality, and productivity expectations.
• Conduct quality audits and training sessions for new hires and experienced associates based on departmental expectations and metrics.
• Perform daily unbilled authorization follow-up and reduction, and process pre-bill denials and P2P work to prevent delayed claims.
• Assist leaders with team engagement and foster a positive environment that supports performance.
• Demonstrate knowledge and skills appropriate to the ages and developmental needs of patients served, in accordance with departmental policies and procedures.

Benefits

• Bonus incentives and quarterly and annual incentive programs.
• Company-paid CRCR certification and paid certifications.
• Tuition reimbursement.
• Comprehensive benefits, including healthcare, time off, retirement, and well-being programs.
• Career advancement opportunities.
• Professional development and field-relevant certification opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED