Denials Prevention Manager

🕒 May 21

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🏢 Enterprise

💰 Private Equity Round on 2022-03

Healthcare Insurance • SaaS • Enterprise

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• The Denial Prevention Manager leads strategies and operations to minimize claim denials and maximize first-pass resolution across the revenue cycle, ensuring compliance with payer requirements and enterprise standards. • Supervise denial prevention specialists, monitoring KPIs such as denial rates and recovery timelines, and leveraging analytics to identify trends and optimize workflows. • Partners with Billing, Coding, Clinical Documentation, and Client Services teams to ensure accurate claim submission, resolve complex issues, and maintain payer relationships. • Acting as a strategic leader, this position establishes governance frameworks, enforces quality controls, and drives continuous improvement initiatives that enhance operational efficiency and client satisfaction. • 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. • Perform 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.

🎯 Requirements

• Bachelor’s Degree or Equivalent Experience • 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 • 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.

🏖️ Benefits

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