Ensemble Health Partners

Role Description The CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate. - Completes initial patient medical record review within 24-48 hours of patient's admission; completes subsequent reviews of patient's medical record reviews every 24-48 hours and enters review findings in CDE software system. - Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluates for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software. - Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used. - Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record. - Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters. - Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge. - Maintains and upholds all clinical documentation regulatory guidelines. - Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-workers and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials. Qualifications - Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience. - Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations. - Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills. - 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. Requirements - Current RN Licensure. - CRCR Required within 9 months of hire. Benefits - Bonus Incentives. - Paid Certifications. - Tuition Reimbursement. - Comprehensive Benefits. - Career Advancement.

• Manage onboarding and occupational health requirements for assigned book of business. • Create and maintain standard operating procedures on assigned book of business. • Interpret occupational health medical results and determine appropriate vaccinations required based on assigned clients. • Responsible for navigating conversations with new hires and integrating associates to guide them through the onboarding process. • Provide exceptional candidate experience to new hires while maintaining strong relationships across all onboarding partners. • Review onboarding requirements for accuracy and determine employment eligibility based on findings. • Consistent partnership with Talent Acquisition Leadership to review escalations and proactively mitigate risks. • Navigate difficult conversations with heightened discretion. • Maintain understanding of internal and external system integrations to troubleshoot system gaps. • Continuously refine and implement onboarding controls and audits to reduce risk. • Execute additional HR projects as assigned.

• Create requests/tickets from standardized HR-generated reports or approved intake lists (e.g., new hires, changes, terminations, access adjustments). • Perform initial triage: confirm assignment group/queue, categorize request type, and route to the correct operational owner. • Act as a centralized escalation contact for the IAM/Provisioning team: respond to escalation inquiries with ticket status, documented blockers, and next steps. • Maintain a simple tracker/report view to support daily/weekly operational updates. • Follow IT support standards, procedures, and documentation expectations; identify recurring issues, missing data patterns, or workflow gaps and share improvement recommendations to leadership.

• Lead the development, implementation, and maintenance of complex IT systems and networks • Oversee the design and implementation of hardware and software systems • Ensure network security and participate in daily IT operations • Manage and provide support for systems integrations, automation scripts, and improve existing technology • Collaborate with other IT teams to identify areas for automation to improve operational efficiency • Develop and implement IT policies and procedures for network and system security • Provide training and support to end-users on technology systems and processes • Monitor and manage network and system performance to ensure uptime and availability • Regularly report to management on IT projects, system performance, and network security.

• Reporting directly to VP, Patient Access, establish processes and policies for Patient Access • Determine and set strategy for Patient Access • Identify and implement strategies to improve processes • Promote operational efficiency, enhance patient experience and meet regulatory compliance guidelines • Engage and collaborate with operational leadership and staff • Provide vision, leadership and operational oversight for Patient Access functions • Establish positive, collaborative relationships with operational leaders • Travel within assigned markets up to 75% of the time

Role Description The Accounts Receivable Associate Specialist is responsible for following up directly with commercial, governmental, and other payers to resolve claim payment issues, to secure appropriate and timely reimbursement and response. This includes: - Identifying and analyzing denials, payment variances, and no response claims. - Drafting and submitting technical and clinical appeals. - Providing support for all denial, no response, and audit activities. Essential Job duties include: - Examining denied and other non-paid claims to determine the reason for discrepancies. - Communicating directly with payers to follow up on outstanding claims, file technical and clinical appeals, resolve payment variances, and ensure timely and accurate reimbursement. - Identifying specific reasons for underpayments, denials, and causes of payment delays. - Maintaining a thorough understanding of federal and state regulations, as well as payer-specific requirements. - Documenting all activity accurately, including contact names, addresses, phone numbers, and other pertinent information. - Demonstrating initiative and resourcefulness by making recommendations and communicating trends and issues to management. - Being a strong problem solver and critical thinker to resolve accounts. Qualifications - Must demonstrate basic computer knowledge and proficiency in Microsoft Excel. - Excellent verbal skills. - Problem-solving skills, with the ability to determine a plan of action for collection. - Critical thinking skills, with the ability to comprehend tools for securing payment. - Adaptability to changing procedures and a growing environment. - Ability to meet quality and productivity standards within timelines. - Must be inquisitive and open to innovation, including AI. Requirements - This is a remote position; candidates must be willing to travel to and work onsite as business needs require. - 1 or more years of relevant experience in medical collections, physician/hospital operations, AR follow-up, denials & appeals, compliance, or professional billing preferred. - Knowledge of claims review and analysis. - Working knowledge of revenue cycle. - Experience with the DDE Medicare system and using payer websites. - Working knowledge of medical terminology and/or insurance claim terminology. Benefits - Remote role. - Bonus incentives. - Paid certifications. - Tuition reimbursement. - Comprehensive benefits. - Career advancement. - This position pays between $17.00 - $18.65/hr based on experience.

Title: Manager Accounts Receivable locations Remote - Nationwide time type Full time job requisition id R041069 Job Description: 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: Job Description 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 Manager, Accounts Receivable will support the designated leadership team in Revenue Cycle in the selection, direction and development of Accounts Receivable department team members, and will report to the Director, Revenue Cycle. The Manager will be responsible for assisting team members with problematic claims and answering questions regarding operational processes. The Manager, Accounts Receivable is responsible for performance and effectiveness of the department's staff. The Manager, Accounts Receivable will be responsible for developing short and long-term plans and objectives to improve revenue and manage overall payment and 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 their peers in Coding and Billing 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. 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. Performs ongoing process improvement of daily activities related to accounts receivable functions to ensure processes are performed efficiently and effectively. Obtains or generates reports to analyze trends in unpaid claims and denial activity; works with appropriate departments to resolve recurring issues and correct the underlying causes for errors; Provides relevant guidance to department Supervisors to resolve internal and external issues Develops and manages departmental budget, including overtime. Prepares 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 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. Provides timely communication to peers and team members to ensure continuity across the Revenue Cycle of any new programs, payers, clients, directives. Plans agendas and leads meetings, as appropriate, to enhance communication, including providing notes from meetings to all attendees. 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 / Certification CRCR, People Leadership Experience 3 to 5 years Preferred Area of Study Bachelors Degree or Equivalent Experience Expected Knowledge, Skills, and Abilities - Minimum Years and Type of Experience: Three years’ management experience in healthcare industry. - Medicare and Medicaid billing experience required. - Must have specific HIS computer systems knowledge (i.e. Epic, Cerner, Meditech, etc) and intermediate experience in using Microsoft Excel. - Excellent Verbal skills. - Problem solving skills, the ability to look at account and determine a plan of action for collection. - Critical thinking skills, the ability to comprehend tools provided for securing payment, and apply them to differing accounts to result in payment. - Adaptability to changing procedures and growing environment. - Proficient knowledge of Medicare, Medicaid and other third-party payer documentation, coding and billing regulations Other Knowledge, Skills, and Abilities Preferred: - Advanced Degree. - 3-5 years of relevant experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations or professional billing preferred. - Knowledge of claims review and analysis. - Working knowledge of revenue cycle. - Experience working the DDE Medicare system and using payer websites to investigate claim statuses. - Working knowledge of medical terminology and/or insurance claim terminology. Join an award-winning company Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 - Innovation - Work-Life Flexibility - Leadership - Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: - Associate Benefits – We offer a 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. - Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation. - Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. - Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. Ensemble 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 also prohibits harassment of applicants or employees based on any of these protected categories. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.

• Independent monitor and manage vulnerabilities across Tenable, Wiz, Defender for Cloud, and other platforms. • Lead the assessment of reported vulnerabilities, triage them, and rank them by risk and other mitigating control factors. • Set a strategic prioritization schedule for remediation and work with patching teams to ensure timely patching. • Proficiency with ticketing tools, raising appropriate patch requests, keeping record of the pending requests, following them up on regular basis and tracking them down till resolution. • Manage risk exception procedures and ensure tools exclude findings with granted risk exceptions. • Stay at the forefront of vulnerability trends and provide recommendations for improving vulnerability management processes. • Manage CSPM components to ensure the security of cloud environments, including continuous security assessments, risk prioritization, compliance monitoring, and configuration management. • Detect and address gaps in scan coverage to ensure comprehensive vulnerability assessments. • Generate reports and deliver presentations on vulnerability assessments and remediation progress. • Mentor and train junior team members, fostering skill development and knowledge-sharing. • Contribute to the overall security strategy and engage with executive leadership to enhance security resilience. • Collaborate with cross-functional teams to address complex security issues and ensure effective vulnerability management.

• Lead the performance of deep dive analysis on clinical and technical denials • Identify patterns and trends relative to acute denials • Perform root cause analysis on denied accounts • Guide and influence subject matter experts through assessments of operations • Oversee completion of denial prevention committee reports • Establish and maintain client relationships to drive best practice implementations • Create materials and train denial prevention staff

• 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. • 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.