Denials Specialist

Ensemble Health Partners

22h•Hybrid

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 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.

Requirements

1 to 3 Years Job Experience
Associate’s degree or Equivalent Experience Required
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.

Responsibilities

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