Remote Denials RN Coordinator – Appeals Expert

Ensemble Health Partners; Blue Ash (OH); On-site; USD 63,000 - 80,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Job summary

Ensemble Health Partners is seeking a Denials RN Coordinator to prepare appeals for clinical and technical claim denials across client hospital facilities. The role involves reviewing denials, underpayments, and medical records to determine eligible payment amounts while coordinating with the Clinical Denial and Case Management teams.

The ideal candidate holds an RN license, 5–7 years in revenue cycle/denials, and a Bachelor’s degree.

Qualifications

• 5+ years in revenue cycle/denials, utilization review, or case management preferred.
• Must pass typing test of 45 words per minute (error adjusted).
• Demonstrated advanced usage of AI and management of teams using AI to drive process improvements.

Responsibilities

• Review complex claims denials and escalate for provider, member, or IRO/ALJ appeal.
• Extensive review of medical records to determine necessity criteria and accuracy of denials.
• Prepare written letters of appeal and file appeals in a timely manner; liaison between providers for documentation.

Skills

Revenue cycle

AI in ops

Leadership

Mentoring

Communication

Education

Bachelor's degree

Job description

Ensemble Health Partners is seeking a Denials RN Coordinator to prepare appeals for clinical and technical claim denials across client hospital facilities. The role involves reviewing denials, underpayments, and medical records to determine eligible payment amounts while coordinating with the Clinical Denial and Case Management teams.

The ideal candidate holds an RN license, 5–7 years in revenue cycle/denials, and a Bachelor’s degree.