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Denial Prevention Manager

extra holidays - extra parental leave - fully flexible
Remote: 
Full Remote
Contract: 
Salary: 
63 - 120K yearly
Experience: 
Mid-level (2-5 years)
Work from: 

Offer summary

Qualifications:

Bachelor’s Degree or Equivalent Experience, CRCR or CRCP-IE Certification Required, Medicare and Medicaid audit experience, Strong knowledge of billing regulations, COC/CCS/CIC, RN/LPN/BSN preferred.

Key responsabilities:

  • Oversee monitoring and reporting of denials
  • Improve processes and resolve issues
  • Manage hiring, training, and team performance
  • Document fraud prevention findings and trends
  • Prepare training materials for staff
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Ensemble Health Partners XLarge http://www.EnsembleHP.com/
10001 Employees
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Job description

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners 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

The Opportunity:

CAREER OPPORTUNITY OFFERING:

  • Bonus Incentives
  • Paid Certifications
  • Tuition Reimbursement
  • Comprehensive Benefits
  • Career Advancement
  • This position pays between $62,500.00 - $119,700.00/hr based on experience


­­­­The Manager, Denial Prevention provides oversight of all activities related to the monitoring, tracking and reporting of clinical and technical denials received for all acute facilities and trends activities related to write-offs and first-pass denials to coordinate with the hospitals, revenue cycle, and managed care to reduce those denials through process improvement and education. The Manager oversees a team of analysts and liaisons that produce and trend this data while coordinating the actionable items with the facilities.

Essential Job Functions:

  • Performs ongoing process improvement of daily activities related to denials functions to ensure processes are performed efficiently and effectively; and works with appropriate departments to resolve recurring issues and correct underlying root causes for errors.
  • Provides relevant guidance and works to resolve issues escalated by Service Line Supervisors, Operational Leader(s), Client Leader(s), and other participants related to denial avoidance.
  • Responsible for interviewing, hiring, staffing, training, performance management and development of staff. Counsel and disciplines employees when necessary, in accordance with department and/or organizational policies. Develops, updates and implements job standards, job duties, departmental policies and performance appraisals for all areas of responsibility.
  • Provides operational support to Service Line Analyst(s) and Supervisor(s)
  • Oversee documentation of trends denial prevention findings into defined templates or create reports or summaries as needed. Performs reviews using all patient accounting, Host, Epic and related systems used across Ensemble Health Partners and summarizes trends concisely and actionably.
  • Assists in strategic planning and establishes departmental goals to optimize performance and meet budgetary goals while improving operations to increase Client satisfaction and meet the financial goals of the organization
  • Creates materials and trains Service Line Analysts, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting assigned client(s) and operational area(s)
  • Performs other duties as assigned
  • Travel to Client site(s) as needed


This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Ensemble Required License:

CRCR or CRCP-I

Education Level:

Bachelor’s Degree or Equivalent Experience

Preferred Knowledge, Skills and Abilities:

  • Strong consideration given to CCS/COC/CIC and/or RN/LPN/BSN (does not need to be current)
  • Medicare and Medicaid audit experience required.
  • Proficient knowledge of Medicare, Medicaid and other third-party payer documentation, coding and billing regulations; Strong written and verbal communication skills to communicate in clear, concise terms to management at all levels and the ability to articulate complex regulatory information in layman's terms


Join An Award-winning Company

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

  • 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 Health Partners 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 Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners 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 TA@ensemblehp.com.

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.

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Experience

Level of experience: Mid-level (2-5 years)
Industry :
Spoken language(s):
English
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