The posting
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!
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.
The Opportunity:
The Bedded Insurance Authorization Senior 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 also responsible for conducting staff training, and onboarding, quality audits, Unbilled clean-up and reduction and Pre-Bill Denials processing. While performing these functions they are required to maintain the mission and goals of Ensemble Health Partners and all regulatory compliance requirements.
Job Responsibilities:
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.
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.
- Responsible for reviewing visit data to ensure appropriate and accurate clinical information is provided to the payor to support the authorization request and follow-up timely for authorization securement.
- Among the expectations of this role, the Senior Specialist will achieve: >95% accuracy/quality and productivity while assisting with and monitoring Specialist assignments
- Conducts quality audits and training sessions for new hires and seasoned associates based on departmental expectation and metrics.
- Prevention of delayed claims process through daily Unbilled authorization follow-up and reduction and Pre-Bill Denials & P2P processing.
- Assists leaders with team engagement while fostering positivity for driving performance
- 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.
Experience:
- 2 years of customer service experience
- 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
Required Education:
- High School Diploma/GED Required
Preferred Education:
- 2 Year/ Associates Degree Medical Assisting or Practical Nursing
Certification:
- CRCR Required within 6 months of hire (Company Paid)
Join an award-winning company
Five-time winner of “Best in KLAS” 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024
- Innovation
- Work-Life Flexibility
- Leadership
- Purpose + Values
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
- Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
- Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
- Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
- Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
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, 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.
Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States.
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 [email protected].
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.
Employment Disclaimers – Ensemble
