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. They are responsible for performing these functions while meeting the mission and goals of Ensemble Health Partners and all regulatory compliance requirements.  The Bedded Insurance Authorization Specialist will work within the policies and processes as they are being performed across the entire organization.

- 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 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. Among the expectations of this role, the Specialist will achieve:  >95% accuracy/quality and productivity.

Qualifications:

• 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.
• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit. 
• Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets 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.
• 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.

Minimum Years and Type of Experience:

• Hospital experience preferred

Required Minimum Education:

• High School Diploma or GED
• Certified Revenue Cycle Representative (CRCR) required within 9 months of hire -Company Paid  

Preferred Education:

• 2 Year/ Associates Degree
• Specialty/Major: Medical Assisting or Practical Nursing