Ensemble Health Partners is a hospital and healthcare company that partners with client hospitals to help them develop processes, train teams, reach their financial and operational
Denials Prevention Manager
Location
United States
Posted
7 days ago
Salary
$62.5K - $119.7K / year
Seniority
Senior
Job Description
Denials Prevention Manager
Ensemble Health Partners
• 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.
Job Requirements
- Bachelor’s Degree or Equivalent Experience
- Strong consideration given to CCS/COC/CIC and/or RN/LPN/BSN (does not need to be current)
- Medicare and Medicaid audit experience required.
- Proficient knowledge of Medicare, Medicaid and other third-party payer documentation, coding and billing regulations
- Strong written and verbal communication skills to communicate in clear, concise terms to management at all levels and the ability to articulate complex regulatory information in layman's terms
- Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.
Benefits
- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits
- Career Advancement
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