Denials Prevention Manager

Ensemble Health Partners•Work at Home - Virginia - Other, VA

3d•$62,500 - $119,700•Remote

About The Position

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: 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 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. This role oversees proactive denial management programs—analyzing root causes, implementing corrective actions, and driving process improvements that reduce financial risk and accelerate reimbursement.

Requirements

CRCR or CRCP-I
Bachelor’s Degree or Equivalent Experience
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.

Nice To Haves

CCS/COC/CIC and/or RN/LPN/BSN (does not need to be current)

Responsibilities

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