Denial Prevention Process Improvement Advisor

Ensemble Health Partners; United States; Remote; USD 62,000 - 120,000; Full time

Job summary

Ensemble Health Partners is seeking a Denial Prevention Process Improvement Advisor to lead analysis on clinical and technical denials. This client-facing role involves overseeing denial prevention reports, maintaining relationships, and recommending process improvements. The ideal candidate will have a Bachelor's degree in Healthcare Administration and strong analytical skills.

Benefits

Bonus Incentives

Paid Certifications

Tuition Reimbursement

Qualifications

• 4-year degree in Healthcare Administration or related field required.
• Preferred: Graduate Degree (Master's).

Responsibilities

• Lead monthly denial prevention meetings with client leadership.
• Provide strategic advice on process improvements to address root causes of denials.
• Document findings and create reports on denial trends.

Skills

Project work

Intermediate Excel

Project Management

Data Analytics

Education

4-year/Bachelor's Degree in Healthcare Administration

Graduate Degree (Master's)

Job description

Denial Prevention Process Improvement Advisor

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

The Denial Prevention Process Improvement Advisor leads deep dive analysis on clinical and technical denials for their respective client, utilizing analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends. They perform root cause analysis on denied accounts, extrapolate causes across denial trends, and guide subject matter experts in assessing operations and developing policies, procedures, and tip sheets to address root causes. This role is client-facing, overseeing denial prevention reports, attending meetings, maintaining client relationships, and recommending process improvements to reduce denials, contributing to the Payment Integrity Team's goals.

Essential Job Functions:

• Resolve issues escalated by Revenue Cycle Site Directors related to denial prevention
• Lead monthly denial prevention meetings with client leadership, discussing trends, progress, and next steps
• Build strong relationships with stakeholders including Finance Leadership, Revenue Cycle, Managed Care, and hospital departments
• Document findings and create reports on denial trends
• Review patient accounting and system data to verify trends
• Provide strategic advice on process improvements to address root causes of denials
• Create training materials and train staff on denial trends and issues
• Perform other duties as assigned

Minimum Education Requirements:

4-year/Bachelor's Degree in Healthcare Administration, Business, or related field

Preferred Education:

Graduate Degree (Master's)

Skills and Knowledge:

Project work, Intermediate Excel & Access, Project Management, Data Analytics

Certifications (Preferred):

Certified Specialist Managed Care (CSMC); LEAN Six Sigma Black Belt; Certified Revenue Cycle Representative (CRCR)

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), HFMA MAP Awards (2019-2024), Everest Group's RCM Operations PEAK Matrix (2024), HBI Revenue Cycle Awards (2020, 2022-2023), Fortune Best Workplaces in Healthcare (2024), Monster Top Workplace (2024), Great Place to Work (2023-2024)

We offer comprehensive benefits supporting health, well-being, and professional growth, including healthcare, time off, retirement, tuition reimbursement, and certification support. Our culture emphasizes collaboration, growth, and innovation, empowering our associates to excel and be their best selves.

Ensemble is committed to equal employment opportunity and providing reasonable accommodations for qualified individuals with disabilities. For accommodations, contact [e-mail].

Pay transparency is addressed in accordance with applicable laws, considering various factors such as location, experience, education, and internal equity.

Ensemble Health Partners is a leading revenue cycle management company dedicated to building relationships and delivering the best solutions to your challenges.