Denials Specialist

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:

ENTRY LEVEL CAREER OPPORTUNITY OFFERING:

Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $18.65 to $25.00/hr based on experience

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:

2 years of denials or accounts receivable

Type 35 wpm Experience in hospital operations, chart audit/review, and provider relations

Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Join an award-winning company

Five-time winner of “Best in KLAS” , Black Book Research's Top Revenue Cycle Management Outsourcing Solution Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, Energage Top Workplaces USA Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 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…