Senior Denial Prevention Process Improvement Advisor

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:

CAREER OPPORTUNITY OFFERING:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement

The salary range for this position is $69,000.00 to $104,100.00. Final offers are based on experience and geo zone.

­­­­The Denial Prevention Process Improvement Advisor leads the performance of deep dive analysis on clinical and technical denials for his or her respective client, utilizing multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends relative to acute denials. The Denial Prevention Process Improvement Advisor applies high level problem-solving skills to perform root cause analysis on denied accounts as transactions and extrapolates those causes across large volumes identified as denial trends for assigned facilities. The Denial Prevention Process Improvement Advisor then uses process improvement expertise and persuasion skills to guide and influence subject matter experts through assessments of operations and preparation of policies, procedures, and tip sheets that assist in remedying the root cause(s). The Denial Prevention Process Improvement Advisor is client-facing and oversees completion of denial prevention committee reports and summaries for assigned hospitals, attends monthly denial prevention committee meetings, liaises as primary contact for assigned client on revenue cycle related-denials issues, establishes and maintains client relationships to drive best practice implementations, and utilizes sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues impacting denials. This is done in facilitation and addition to an expectation of contributing to the overarching goals of the Payment Integrity Team and Ensemble as a whole.

Essential Job Functions:

• Provides relevant guidance and works to resolve issues escalated by Revenue Cycle Site Directors, and other participants related to denial prevention

• Leads monthly Denial Prevention onsite week kick-off and close-out meetings with assigned client leadership, covering necessary information relative to identified trends, progress from prior actions, and next steps.

• Establishing strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads

• Oversees documentation and trends prevention-related findings into defined templates, initiating or creating reports or summaries as needed.

• Leads reviews using all patient accounting, host, Epic and related systems used across their client to verify and summarize trends concisely and actionably.

• Aggregates and provides strategic advisory perspective related to process improvement and quality in assessment of the root cause issues creating denials by working with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues.

• Creates materials and trains denial prevention staff, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting their client.

• Performs other duties as assigned

Required Minimum Education:

4 year/ Bachelors Degree

Specialty/Major:

Healthcare administration, Business or related discipline 

Preferred Education:

Graduate Degree (Masters)

Other Knowledge, Skills and Abilities Required:

* Project Work, Intermediate Excel & Access Skills

* Project Management, Data Analytics

* Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.

* This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Licensure/Certification Preferred:

* Certified Specialist Managed Care (CSMC); LEAN Six Sigma Black Belt

* Certified Revenue Cycle Representative: (CRCR)

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.

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 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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