Denials Manager

Thank you for considering a career at Ensemble Health Partners!

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!

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
• This position pays between $62,500.00 - $119,700.00/based on experience

The Manager, Appeals Operations provides oversight of all activities related to the monitoring, tracking and reporting of audit requests and the appeals associated with audit and non-audit related denials. The Manager is responsible for performance and effectiveness of the department's clinical staff. The Manager will be responsible for implementing short and long-term plans and objectives to improve revenue and manage overall clinical denials trends. Additionally, they will be responsible for working with insurance companies to identify reasons for denied payment for services. The Manager will work with Patient Access, Coding, Billing, and Follow-Up to identify, correct, and reduce denials trends related to their respective departments. They will empower staff to develop methods of process improvement, including planning, setting priorities, conducting systematic performance assessments, implementing improvements based on those assessments and maintaining achieved improvements.

Essential Job Functions:

• Performs ongoing process improvement of daily activities related to audit and denial functions to ensure processes are performed efficiently and effectively; Generates reports to analyze trends in audit and denial activity and works with appropriate departments to resolve recurring coding or clinical documentation issues and correct the underlying causes for errors; Provides relevant guidance to department Supervisors to resolve internal and external issues.

• 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.

• Develops and manages departmental budget. Prepare monthly reports as requested. Establishes departmental goals with the staff to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet financial goals of the organization.

• Collects, interprets and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals. Works with internal and external customers to make key decisions, impacting either the organization as a whole or an individual patient. Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved.

• Assists in strategic planning and establishes departmental goals to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet the financial goals of the organization.

• Performs other duties as assigned

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.

Ensemble Required License:

CRCR or CRCP-I

Preferred Knowledge, Skills and Abilities:

• 4 year/ Bachelors degree
• Three years’ management experience in healthcare industry.
• Medicare and Medicaid billing 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

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 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 [email protected].

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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