Denials Specialist

Ensemble Health Partners; Connecticut; Hybride; USD 42 000 - 64 000; Plein temps

Avantages offerts par ce poste

Bonus incentives

Tuition Reimbursement

Comprehensive Benefits

Career advancement

Résumé du poste

Ensemble Health Partners is hiring a Denials Specialist for our US operations. The role focuses on clinically related claim denials, contacting plans, analyzing reasons for denials, and determining if appeals are needed.

Responsibilities include preparing appeal materials, gathering medical records, and coordinating with providers to obtain necessary documentation for timely submissions. Entry level with opportunities for growth and advancement.

Qualifications

• 1–3 years of denials or accounts receivable experience.
• Associate’s degree or equivalent experience required.
• Knowledge of hospital operations, chart audit/review, and provider relations is preferred.

Responsabilités

• Analyze claims, remittances, denial letters, and contact payers to determine root causes of denials and steps to resolution.
• Assess claims and determine if an appeal is necessary.
• Prepare appeal materials, including correcting and resubmitting claims and gathering medical records.
• Act as liaison between healthcare providers for documentation and clarification, and submit appeals timely.

Connaissances

Denials management

Revenue cycle knowledge

Medical records review

Communication skills

Formation

Associate’s degree or Equivalent Experience

Outils

EMR/EHR systems

AI in processes

Description du poste

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

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” 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 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 also prohibits harassment of applicants or employees based on any of these protected categories. Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States. Ensemble 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 [e-mail].

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.

If you are a passionate, dedicated and experienced revenue cycle, consulting or finance professional and seek career and personal growth, we would love to hear from you. We believe we foster an environment where talented individuals can excel and shine. Our team believes that people are the most important part of our success and that when we take care of our people, they pay it forward by providing our clients with excellent results and world-class service.