[Hiring] Denials Prevention Manager @Ensemble Health Partners

Role Description

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. This role oversees proactive denial management programs—analyzing root causes, implementing corrective actions, and driving process improvements that reduce financial risk and accelerate reimbursement.

• Supervise denial prevention specialists, monitoring KPIs such as denial rates and recovery timelines, and leveraging analytics to identify trends and optimize workflows.
• Partner with Billing, Coding, Clinical Documentation, and Client Services teams to ensure accurate claim submission, resolve complex issues, and maintain payer relationships.
• Establish governance frameworks, enforce quality controls, and drive continuous improvement initiatives that enhance operational efficiency and client satisfaction.
• Responsible for interviewing, hiring, staffing, training, performance management, and development of staff.
• Counsel and discipline employees when necessary, in accordance with department and/or organizational policies.
• Develop, update, and implement job standards, job duties, departmental policies, and performance appraisals for all areas of responsibility.
• Provide 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 summarize trends concisely and actionably.
• Assist in strategic planning and establish departmental goals to optimize performance and meet budgetary goals while improving operations to increase Client satisfaction and meet the financial goals of the organization.
• Create materials and train 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).
• Perform other duties as assigned.
• Travel to Client site(s) as needed.

Qualifications

• CRCR or CRCP-I required.
• 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.
• Ability to articulate complex regulatory information in layman's terms.
• Demonstrated advanced usage of AI and the management of teams using AI to lean into process and technological improvements.

Requirements

• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Benefits

• Bonus Incentives.
• Paid Certifications.
• Tuition Reimbursement.
• Comprehensive Benefits.
• Career Advancement.