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Bedded Insurance Authorization Specialist
Ensemble Health PartnersInsurance Authorization Specialist verifying coverage and securing authorizations for hospital patients. Supporting Ensemble’s technology-enabled healthcare revenue cycle management services and preventing payer denials.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance authorization processes, including verification of eligibility, benefits, and compliance with payer-specific criteria. Possesses strong problem-solving abilities and effective communication skills to manage patient interactions and documentation requirements.
Highest-signal resume keywords
Insurance Authorization ExperienceCPT Code KnowledgeCritical Thinking SkillsCertified Revenue Cycle Representative (CRCR)Medical Terminology Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance VerificationClinical Documentation ReviewAuthorization SecurementPatient Liability CalculationRegulatory ComplianceMedical Necessity AssessmentPayer-Specific Criteria AnalysisDeductible and Copayment ManagementPre-Certification Systems AccessPatient Data Assessment
Soft Skills
Verbal Communication SkillsWritten Communication SkillsProblem-Solving SkillsStress ManagementPositive Demeanor
Tools & Technologies
Personal ComputersStandard Office EquipmentOnline Insurance Eligibility Systems
Certifications & Qualifications
Certified Revenue Cycle Representative (CRCR)
Industry Keywords
Insurance CompaniesMedical AuthorizationsHospital ExperiencePatient CareContract Benefits
About the role
Key responsibilities & impact- Perform initial and concurrent insurance authorization securement, clinical submission, and denial prevention for hospital patients
- Confirm insurance activation, coverage, effective dates, limitations, requirements, and patient liabilities
- Check deductibles, coinsurance, and copayment amounts and notify patients of estimated amounts due when applicable
- Verify and document insurance eligibility and benefits
- Review and submit clinical documentation supporting diagnosis, treatment, services, and medical necessity
- Obtain, verify, maintain, and timely renew initial and subsequent insurance authorizations
- Review patient visit information and payer-specific criteria to determine authorization requirements
- Ensure services are within benefit plans and eligible members use appropriate contracted providers
- Review visit data and provide accurate information to payers to support authorization requests and timely follow-up
- Achieve greater than 95% accuracy/quality and productivity
- Work within organizational policies, processes, mission, goals, and regulatory compliance requirements
Requirements
What you’ll need- 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
- Ability to retain material quickly
- Positive demeanor and solid verbal and written communication skills
- Professional appearance and approach
- Ability to handle considerably stressful situations and multiple tasks simultaneously
- Working knowledge of personal computers and standard office equipment
- Ability to access online insurance eligibility and pre-certification systems
- Ability to successfully complete additional job-related training
- Knowledge and skills to provide age-appropriate care and assess patient data according to patients’ developmental and specific needs
- High School Diploma or GED
- Certified Revenue Cycle Representative (CRCR) required within 9 months of hire; company paid
- Hospital experience preferred
- Associate degree in Medical Assisting or Practical Nursing preferred
Benefits
Comp & perks- Remote Work
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits, including healthcare, time off, retirement, and well-being programs
- Career Advancement
- Professional development investment
- Quarterly and annual incentive programs
- Work-life flexibility