Denials Manager

Manager, Appeals Operations

Ensemble Health Partners 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!

The Manager, Appeals Operations provides oversight of all activities related to the monitoring, tracking and reporting of audit requests and the appeals associated with audit and non-audit related denials. The Manager is responsible for performance and effectiveness of the department's clinical staff. The Manager will be responsible for implementing short and long-term plans and objectives to improve revenue and manage overall clinical denials trends. Additionally, they will be responsible for working with insurance companies to identify reasons for denied payment for services. The Manager will work with Patient Access, Coding, Billing, and Follow-Up to identify, correct, and reduce denials trends related to their respective departments. They will empower staff to develop methods of process improvement, including planning, setting priorities, conducting systematic performance assessments, implementing improvements based on those assessments and maintaining achieved improvements.

Essential Job Functions :

• Performs ongoing process improvement of daily activities related to audit and denial functions to ensure processes are performed efficiently and effectively; Generates reports to analyze trends in audit and denial activity and works with appropriate departments to resolve recurring coding or clinical documentation issues and correct the underlying causes for errors; Provides relevant guidance to department Supervisors to resolve internal and external issues.
• 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.
• Develops and manages departmental budget. Prepare monthly reports as requested. Establishes departmental goals with the staff to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet the financial goals of the organization.
• Collects, interprets and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals. Works with internal and external customers to make key decisions, impacting either the organization as a whole or an individual patient. Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved.
• Assists in strategic planning and establishes departmental goals to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet the financial goals of the organization.
• Performs other duties as assigned.

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.

Ensemble Required License : CRCR or CRCP-I

Preferred Knowledge, Skills and Abilities :

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Ensemble Health Partners 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 Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners 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 TA@ensemblehp.com.