Bedded Insurance Authorization Specialist

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

📋 Description

• Conduct initial and ongoing insurance authorization processes, clinical submissions, and denial prevention for patients in the hospital setting.

• Verify insurance activation, coverage details, effective dates, limitations, requirements, and patient financial responsibilities.

• Assess deductibles, coinsurance, and copayment amounts, and inform patients of estimated dues when necessary.

• Confirm and document insurance eligibility and benefits accurately.

• Review and submit clinical documentation that supports the diagnosis, treatment, services, and medical necessity.

• Obtain, verify, maintain, and promptly renew initial and subsequent insurance authorizations.

• Analyze patient visit data and payer-specific criteria to ascertain authorization requirements.

• Ensure that services comply with benefit plans and that eligible members utilize appropriate contracted providers.

• Examine visit data and supply accurate information to payers to facilitate authorization requests and ensure timely follow-up.

• Strive for over 95% accuracy, quality, and productivity in all tasks.

• Adhere to organizational policies, processes, mission, goals, and regulatory compliance standards.

⛳️ Requirements

• Experience in dealing with insurance companies and/or managing medical authorizations.

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

• Strong critical thinking and problem-solving abilities.

• Quick material retention skills.

• Positive attitude with excellent verbal and written communication skills.

• Professional demeanor and appearance.

• Capability to manage high-stress situations and juggle multiple tasks simultaneously.

• Proficient in using personal computers and standard office equipment.

• Ability to navigate online insurance eligibility and pre-certification systems effectively.

• Willingness to successfully complete additional job-related training.

• Skills and knowledge necessary to provide age-appropriate care and evaluate patient data based on their developmental and specific needs.

• High School Diploma or GED required.

• Certified Revenue Cycle Representative (CRCR) certification is mandatory within 9 months of hire; the company will cover the costs.

• Prior hospital experience is preferred.

• An Associate degree in Medical Assisting or Practical Nursing is preferred.

🏝️ Benefits

• Opportunity to work remotely.

• Bonus incentives available.

• Paid certification opportunities.

• Tuition reimbursement program.

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

• Opportunities for career advancement.

• Investment in professional development.

• Quarterly and annual incentive programs.

• Flexibility to maintain work-life balance.