[Hiring] Denials Specialist @Ensemble Health Partners

Role Description

The Denials Specialist is responsible for clinically related claim denials across Ensemble Health Partners. Job duties include, but are not limited to:

• Contacting insurance plans to determine reasons claims were denied.
• Analyzing the claims and determining if an appeal is necessary.
• Preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records.
• Acting as a liaison between healthcare providers for any additional medical documentation or clarification and submitting appeals in a timely manner.

Essential Job Functions:

• Analyze claims, remittances, denial letters, and contact payers to effectively determine root causes for denials and steps to resolution.
• Meets quality and productivity standards - able to accurately type, format, and draft appeal letters.

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.

Qualifications

• 1 to 3 years of experience.
• Associate’s degree or equivalent experience.
• 2 years of denials or accounts receivable experience.
• Type 35 wpm.
• Experience in hospital operations, chart audit/review, and provider relations.
• 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

• Knowledgeable in Revenue Cycle terminology and processes; able to effectively triage denials for appropriate actions to be taken.

Benefits

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

This position pays between $18.65 to $25.00/hr based on experience.