Senior Denial Prevention Process Improvement Advisor

Ensemble Health Partners

1d • 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. The company recognizes that healthcare requires a human touch and believes that every touch should be meaningful, emphasizing that their people are the most important part of who they are. They empower employees to challenge the status quo, believing they will make a difference. Ensemble's O.N.E Purpose includes Customer Obsession, Embracing New Ideas, and Striving for Excellence.
The Denial Prevention Process Improvement Advisor leads deep dive analysis on clinical and technical denials for their respective client, using multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends related to acute denials. This role involves applying high-level problem-solving skills to perform root cause analysis on denied accounts and extrapolating these causes across large volumes of identified denial trends. The Advisor then uses process improvement expertise and persuasion skills to guide subject matter experts through operational assessments and the preparation of policies, procedures, and tip sheets to remedy root causes. This is a client-facing role that oversees the completion of denial prevention committee reports and summaries, attends monthly committee meetings, acts as the primary contact for clients on revenue cycle-related denial issues, establishes and maintains client relationships to drive best practice implementations, and uses sound judgment to aggregate and advance team recommendations for correcting underlying issues impacting denials. This role also contributes to the overarching goals of the Payment Integrity Team and Ensemble as a whole.

Requirements

• 4 year/ Bachelor's Degree in Healthcare administration, Business or related discipline.
• Project Work experience.
• Intermediate Excel & Access Skills.
• Project Management experience.
• Data Analytics experience.
• Demonstrated advanced usage of AI and the management of teams using AI to lean into process and technological improvements, to include the exploration, experimentation, and application of AI.
• Willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Nice To Haves

• Graduate Degree (Masters)
• Certified Specialist Managed Care (CSMC)
• LEAN Six Sigma Black Belt
• Certified Revenue Cycle Representative (CRCR)

Responsibilities

• Provides relevant guidance and works to resolve issues escalated by Revenue Cycle Site Directors, and other participants related to denial prevention.
• Leads monthly Denial Prevention onsite week kick-off and close-out meetings with assigned client leadership, covering necessary information relative to identified trends, progress from prior actions, and next steps.
• Establishes strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads.
• Oversees documentation and trends prevention-related findings into defined templates, initiating or creating reports or summaries as needed.
• Leads reviews using all patient accounting, host, Epic and related systems used across their client to verify and summarize trends concisely and actionably.
• Aggregates and provides strategic advisory perspective related to process improvement and quality in assessment of the root cause issues creating denials by working with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues.
• Creates materials and trains denial prevention staff, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting their client.
• Performs other duties as assigned.

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• 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.
• Career Advancement
• Investment in professional development
• Opportunity to earn a professional certification relevant to their field
• Quarterly and annual incentive programs for all employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 501-1,000 employees