Ensemble Health Partners
Overview
Employer Industry: Revenue Cycle Management Solutions What to Expect (Job Responsibilities)
Prepare appeals for clinical and technical claim denials across client hospital facilities Review and analyze medical records to determine appeal necessity and compliance with insurance contract terms Act as a liaison between healthcare providers to gather necessary documentation for appeals Collaborate with the Clinical Appeal team and Case Management Department to track and communicate denial trends Mentor and train Clinical Denial and Underpayment team members to enhance team performance What is Required (Qualifications)
Current Registered Nurse (RN) license 5 to 7 years of relevant experience in healthcare or revenue cycle management Strong understanding of ERISA compliance laws and HIPAA regulations Ability to pass a typing test of 45 words per minute (error adjusted) Experience in medical necessity criteria review and filing appeals How to Stand Out (Preferred Qualifications)
Bachelor’s degree in a related field 2 years of experience in denials, utilization review, or case management 5+ years of experience in revenue cycle, legal nurse consulting, or chart audit/review Proven track record of meeting productivity and quality assurance metrics #RevenueCycleManagement #HealthcareCareers #RemoteWork #CareerDevelopment #EmployeeBenefits We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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Employer Industry: Revenue Cycle Management Solutions What to Expect (Job Responsibilities)
Prepare appeals for clinical and technical claim denials across client hospital facilities Review and analyze medical records to determine appeal necessity and compliance with insurance contract terms Act as a liaison between healthcare providers to gather necessary documentation for appeals Collaborate with the Clinical Appeal team and Case Management Department to track and communicate denial trends Mentor and train Clinical Denial and Underpayment team members to enhance team performance What is Required (Qualifications)
Current Registered Nurse (RN) license 5 to 7 years of relevant experience in healthcare or revenue cycle management Strong understanding of ERISA compliance laws and HIPAA regulations Ability to pass a typing test of 45 words per minute (error adjusted) Experience in medical necessity criteria review and filing appeals How to Stand Out (Preferred Qualifications)
Bachelor’s degree in a related field 2 years of experience in denials, utilization review, or case management 5+ years of experience in revenue cycle, legal nurse consulting, or chart audit/review Proven track record of meeting productivity and quality assurance metrics #RevenueCycleManagement #HealthcareCareers #RemoteWork #CareerDevelopment #EmployeeBenefits We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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