Company Overview
Ensemble Health Partners is a premier provider of technology-enabled revenue cycle management (RCM) solutions for hospitals, health systems, and physician groups nationwide. We offer full-service end-to-end RCM capabilities along with targeted point solutions that empower healthcare providers to improve financial performance and focus on patient care.
We keep communities healthy by helping hospitals thrive. At Ensemble, our people are at the heart of everything we do. We believe in the power of human connection, meaningful interactions, and empowering team members to challenge the status quo and drive meaningful change.
Our Purpose – O.N.E.
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Customer Obsession – Deliver exceptional experiences by truly understanding and exceeding expectations.
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New Ideas – Embrace innovation, leverage technology, and foster a culture of creativity.
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Excellence – Perform at the highest level with integrity, collaboration, and accountability.
The Opportunity
As a Sr. Specialist Denial RN, you will play a critical role in managing complex claim denials, preparing appeals, and ensuring compliance with payer guidelines and regulatory standards. Your clinical expertise and analytical skills will help maximize reimbursement for hospital systems while upholding our mission of excellence in care and service.
Key Responsibilities
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Review and assess denied claims to determine appeal potential at provider, member, or IRO/ALJ levels.
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Analyze medical records for medical necessity and contract compliance to prepare strong appeal documentation.
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Submit timely, well-supported appeals and grievances in compliance with HIPAA, ERISA, and payer-specific requirements.
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Act as a liaison between providers to gather additional documentation or clarification needed for appeals.
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Identify trends in claim denials and underpayments; escalate findings to leadership and partner departments.
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Mentor and train Clinical Denial and Underpayment team members.
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Collaborate with the Clinical Appeal and Case Management teams to share outcomes and trends.
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File complaints with state Departments of Insurance, as appropriate.
Qualifications
Required:
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Registered Nurse (RN) license in good standing.
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Associate’s degree in Nursing or equivalent experience.
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5+ years of experience in one or more of the following: Revenue Cycle, Legal Nurse Consulting, Chart Review/Audit, Provider Relations.
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Must pass a 45 WPM typing test (error-adjusted).
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CRCR certification (or approved equivalent) within 9 months of hire.
Preferred:
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Bachelor’s degree in a relevant field.
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Prior experience with appeal preparation, payer compliance, and legal aspects of healthcare reimbursement.
Why Join Ensemble?
We invest in our people so they can make a difference in healthcare:
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Compensation: Competitive salary based on experience; incentive bonus opportunities.
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Benefits: Comprehensive health, dental, and vision plans, retirement options, paid certifications, and tuition reimbursement.
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Career Growth: Clear advancement paths, professional certification support, and ongoing training.
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Award-Winning Culture:
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“Best in KLAS” winner (2020–2022, 2024–2025)
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Top RCM Outsourcing Solution – Black Book (2021–2024)
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Multiple HFMA MAP Awards (2019–2024)
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Clarivate HBI Revenue Cycle Awards (2020, 2022–2023)
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Fortune Best Workplaces in Healthcare (2024)
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Energage Top Workplaces USA (2022–2024)
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Great Place to Work Certified (2023–2024)
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Equal Opportunity Employer
Ensemble Health Partners is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any legally protected status. We are committed to providing reasonable accommodations to individuals with disabilities during the application and hiring process.