Senior Insurance Authorization Specialist

About the role

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!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

Responsibilities

• Support 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.
• Perform insurance authorization and verification functions while meeting the mission of Ensemble Health Partners and all regulatory compliance requirements.
• Work within the policies and processes as they are being performed across the entire organization.
• Support the Department's Supervisor with the daily workflow and distribution of workload, answer questions as the assigned subject matter expert, assist with mentoring and training new members of the team and report any system or process issues identified.
• Select accurate medical records for patient safety, obtain and validate demographic and insurance information, work 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.
• 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.
• Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.
• Act as the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.
• Perform other duties as assigned.

Experience We Love

• 1-3 years of experience
• 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
• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require

Minimum Education

• High School Diploma/GED Required
• Preferred: 2 Year/Associates Degree

Certifications

• Certified Revenue Cycle Representative (CRCR) required within 9 months of hire – Company Paid

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement

Pay

This position pays between $18.65 - $23.50 based on experience.