Bedded Insurance Authorization Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Facilitate the initial and ongoing authorization of insurance, clinical submissions, and prevention of denials for patients admitted to hospitals.

• Verify that patients’ health insurance is active and provides coverage for necessary procedures.

• Confirm covered benefits, effective policy dates, coverage limitations, requirements, and patient financial responsibilities.

• Assess deductible, coinsurance, and copayment amounts, informing patients of any amounts owed when necessary.

• Validate and document insurance eligibility and benefits accurately.

• Analyze and submit clinical documentation to substantiate treatment appropriateness and medical necessity.

• Obtain, confirm, and maintain insurance authorizations for assigned patients.

• Ensure that both initial and subsequent authorizations are secured promptly.

• Work to reduce and eliminate authorization denials effectively.

• Review patient visit details and payer-specific criteria to ascertain authorization requirements.

• Confirm that services align with benefit plans and utilize appropriate contracted providers.

• Examine visit data for precise payer submissions and ensure timely follow-up.

• Maintain a performance accuracy/quality and productivity rate exceeding 95%.

⛳️ Requirements

• Proven experience in dealing with insurance companies and/or medical authorizations.

• In-depth knowledge of insurance authorization protocols, contract benefits, CPT codes, and medical terminology.

• Strong critical thinking and problem-solving abilities.

• Capability to quickly absorb and retain information.

• Positive attitude along with excellent verbal and written communication skills.

• Capacity to manage high-stress situations and juggle multiple tasks at once.

• Proficient in using personal computers and standard office equipment.

• Ability to access online insurance eligibility and pre-certification platforms.

• Willingness to successfully complete any additional job-related training.

• Possess the knowledge and skills necessary to provide age-appropriate care to patients.

• Familiarity with growth and development principles throughout the lifespan.

• High School Diploma or GED is required.

• Certification as a Revenue Cycle Representative (CRCR) is mandatory within 9 months of hire; costs covered by the company.

• Prior hospital experience is preferred.

• An Associate's Degree in Medical Assisting or Practical Nursing is preferred.

🏝️ Benefits

• Remote Work options available.

• Bonus Incentives offered.

• Paid Certifications supported.

• Tuition Reimbursement provided.

• Comprehensive Benefits package, including healthcare, paid time off, retirement plans, and wellness programs.

• Opportunities for Career Advancement.

• Professional certification relevant to the field is encouraged.

• Access to quarterly and annual incentive programs.

• Reasonable accommodations are available for qualified individuals with disabilities.