Denial Prevention Process Improvement Advisor

Denial Prevention Process Improvement Advisor

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 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 Process Improvement Advisor leads the performance of deep dive analysis on clinical and technical denials for his or her respective client, utilizing multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases / SQL) to identify patterns and trends relative to acute denials. The Denial Prevention Process Improvement Advisor applies high level problem-solving skills to perform root cause analysis on denied accounts as transactions and extrapolates those causes across large volumes identified as denial trends for assigned facilities. The Denial Prevention Process Improvement Advisor then uses process improvement expertise and persuasion skills to guide and influence subject matter experts through assessments of operations and preparation of policies, procedures, and tip sheets that assist in remedying the root cause(s). The Denial Prevention Process Improvement Advisor is client-facing and oversees completion of denial prevention committee reports and summaries for assigned hospitals, attends monthly denial prevention committee meetings, liaises as primary contact for assigned client on revenue cycle related-denials issues, establishes and maintains client relationships to drive best practice implementations, and utilizes sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues impacting denials. This is done in facilitation and addition to an expectation of contributing to the overarching goals of the Payment Integrity Team and Ensemble as a whole.

Essential Job Functions :

Required Minimum Education :

4 year / Bachelors Degree

Specialty / Major : Healthcare administration, Business or related discipline

Preferred Education :

Graduate Degree (Masters)

Other Knowledge, Skills and Abilities Required :

Project Work, Intermediate Excel & Access Skills

Project Management, Data Analytics

Licensure / Certification Preferred :

Certified Specialist Managed Care (CSMC); LEAN Six Sigma Black Belt

Certified Revenue Cycle Representative : (CRCR)

Join an award-winning company

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include :

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.

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range.