Denials Prevention Manager

🕒 vor 1 Monat

Jetzt Bewerben

Ähnliche Remote-Jobs finden

E-Mails für Remote-Jobs erhalten

📊 Überprüfen Sie Ihre Lebenslauf-Bewertung für diese Stelle

Verbessern Sie Ihre Chancen auf ein Vorstellungsgespräch, indem Sie Ihre Lebenslauf-Bewertung vor der Bewerbung überprüfen.

Lebenslauf hochladen

Ensemble Health Partners

WebsiteLinkedInAlle Stellen

5001 - 10000 Mitarbeiter

⚕️ Krankenversicherung

☁️ SaaS

🏢 Unternehmen

💰 Private Equity Round im 2022-03

Healthcare Insurance • SaaS • Enterprise

Ensemble Health Partners ist ein führender Anbieter von Revenue Cycle Management (RCM) Dienstleistungen für Gesundheitseinrichtungen. Sie bieten eine umfassende RCM-Lösung, die Krankenhäuser, Gesundheitssysteme und angeschlossene Ärztegruppen dabei unterstützt, ihre Umsatzzyklen zu optimieren, Ablehnungen und Unterbezahlungen zu reduzieren und Patientenerfahrungen durch eine Kombination aus fachkundigem Management und fortschrittlicher Technologie zu verbessern. Ensemble Health Partners nutzt zertifizierte Fachkräfte und KI, um konsistente Ergebnisse zu liefern, die Einnahmen zu steigern und zukünftiges Wachstum für Gesundheitsdienstleister zu unterstützen. Sie sind bekannt für ihre starken Kundenpartnerschaften und ihr Engagement, zuverlässige Umsatzsteigerungen und Kosteneinsparungen für ihre Kunden zu gewährleisten.

Beschreibung

• 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

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