Denials Specialist

Denials Specialist

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 Denials Specialist is responsible for clinically related claim denials across Ensemble Health Partners. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification and submitting appeals in a timely manner.

Essential Job Functions :

• Analyze claims, remittances, denial letters, and contact payers to effectively determine root causes for denials and steps to resolution
• Analyzing the claims and determining if appeal is necessary
• Preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records
• Acting as a liaison between healthcare providers for any additional medical documentation or clarification and submitting appeals in a timely manner
• Knowledgeable in Revenue Cycle terminology and processes; able to effectively triage denials for appropriate actions to be taken
• Meets quality and productivity standards - able to accurately type, format, and draft appeal letters

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.

Job Experience : 1 to 3 Years

Education Level : Associate's degree or Equivalent Experience

Knowledge, Skills and Abilities :

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

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include :

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.