Full-Time
Denial Prevention Manager
Posted on 9/26/2025
Ensemble Health Partners
5,001-10,000 employees
End-to-end revenue cycle management for hospitals
Compensation Overview
$62.5k - $119.7k/yr
Remote in USA
Remote
 Operations & Logistics (1) |
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- CRCR or CRCP-I or other approved job relevant certification
- Bachelors Degree or Equivalent Experience
- Medicare and Medicaid audit experience required
- Proficient computer skills, including Microsoft Suite
- 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
- Performs ongoing process improvement of daily activities related to denials functions to ensure processes are performed efficiently and effectively; and works with appropriate departments to resolve recurring issues and correct underlying root causes for errors.
- Provides relevant guidance and works to resolve issues escalated by Service Line Supervisors, Operational Leader(s), Client Leader(s), and other participants related to denial avoidance.
- Responsible for interviewing, hiring, staffing, training, performance management and development of staff. Counsels 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)
- Oversees documentation of trends denial prevention findings into defined templates or create reports or summaries as needed. Performs 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
- RN license (unencumbered - no restrictions) is highly preferred
- case management or utilization review experience will be essential
- Strong consideration given to CCS/COC/CIC and/or RN/LPN/BSN (does not need to be current)
- Experience in hospital operations, chart audit/review, and provider relations
Ensemble Health Partners provides end-to-end revenue cycle management for hospitals and health systems. It handles the entire process from patient intake to final payment, with teams and technology embedded into the provider's operations and a revenue model tied to performance improvements. The company uses its proprietary EIQ platform (analytics, AI, and workflow automation) to optimize revenue cycle processes, reduce insurance denials, and speed cash collection, managing more than $39 billion in net patient revenue. Its approach differentiates it by being a true managed-services partner with full accountability for financial outcomes and a track record of meeting initial client goals. The overarching goal is to improve healthcare providers’ financial performance so they can focus on patient care.
Company Size
5,001-10,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Huntersville, North Carolina
Founded
2014
Simplify's Take
What believers are saying
- Cohere partnership deploys agentic AI, automating 40% of AR follow-ups.
- Mary Washington Healthcare partnership expands mid-market client base in 2024.
- Microsoft Azure enhances EIQ with generative AI, securing eight patents.
What critics are saying
- R1 RCM undercuts pricing by 20-30%, eroding mid-market clients by Q1 2026.
- Optum360's DeepMind AI captures large contracts, reducing AR days faster.
- Cohere synthetic data leaks trigger $50M fines and Carilion exodus by Feb 2026.
What makes Ensemble Health Partners unique
- EIQ platform integrates AI for denial reduction and cash acceleration.
- Fixed-rate collections with performance incentives drive client accountability.
- End-to-end RCM embeds teams into client operations for full ownership.
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Benefits
Health Insurance
Professional Development Budget
Performance Bonus
Flexible Work Hours
Comprehensive Benefits
Company News
Ensemble, a US revenue cycle management services provider, has partnered with enterprise AI company Cohere to build the healthcare industry's first revenue cycle management-native large language model. The companies are creating a custom model informed by Ensemble's operational expertise and data, designed to handle complex healthcare financial operations more accurately than general-purpose LLMs. The model will be embedded into AI agents managing processes from patient intake to account resolution. Unlike standard approaches that rely on prompt engineering, this system is fine-tuned on real RCM tasks and trained using synthetic datasets in a HIPAA-compliant environment, without using identifiable patient data. The solution aims to enhance existing electronic health record systems by providing better context and guidance for navigating payer requirements whilst reducing administrative burden for healthcare providers.
The article discusses the transformative impact of technology on healthcare, highlighting Ensemble Health's billion-dollar valuation amid a shift towards AI, telehealth, and extended reality. AI advancements promise personalized medicine, while telehealth evolves with Remote Patient Monitoring. The metaverse emerges as a tool for training and therapy. Challenges include data privacy, interoperability, and cybersecurity. The goal is a more personalized, accessible, and proactive healthcare system.
What You Should Know:– Ensemble, a leading provider of end-to-end revenue cycle management (RCM), has partnered with Cohere, a security-first enterprise AI company, to introduce the first fully integrated agentic AI platform for revenue cycle orchestration in healthcare.– This collaboration merges Ensemble’s decade-long RCM expertise with Cohere’s enterprise-grade AI infrastructure to deliver faster, smarter, and more secure financial operations for hospitals and health systems.Advancing Revenue Cycle Intelligence with Secure, Scalable AI IntegrationEnsemble has integrated Cohere’s enterprise-grade AI models—trained on a decade of Ensemble’s high-performing revenue cycle outcomes—throughout its entire RCM infrastructure. This collaboration represents the inaugural healthcare deployment of Cohere’s North platform, establishing a new benchmark for secure, scalable agentic AI within clinical financial operations, all while ensuring full HIPAA compliance and data integrity.In contrast to traditional, narrowly focused AI tools, Ensemble and Cohere have co-engineered a horizontally deployed network of reasoning-based agents. These AI agents leverage contextual data analysis and adaptive decision-making frameworks to resolve multifaceted revenue cycle challenges, particularly in insurance reimbursement, without depending on inflexible rule sets.A human-in-the-loop architecture reinforces the platform’s operational integrity, embedding rigorous quality assurance mechanisms across every decision layer. Currently, this system autonomously manages more than 40% of accounts receivable (AR) follow-up tasks—previously handled manually—and is on track to expand into additional complex workflows, including prior authorization, utilization management, clinical coding, and denial prevention.The broader AI ecosystem features:• Generative AI trained on clinical documentation to enhance the accuracy and speed of denial appeals• Conversational AI modules designed to streamline patient interactions and reduce call resolution time• Predictive analytics tools for early identification of denial risks• Agent assistants that augment frontline staff productivityThese technologies are already delivering tangible operational benefits, including:• A 40% increase in the speed of denial appeal submissions• A 15% uplift in appeal overturn rates• A 35% reduction in patient call resolution times• Improved overall patient satisfaction metricsCohere was selected for its proven capacity to implement secure AI solutions in highly regulated environments. Its North infrastructure ensures seamless, secure integration across diverse platforms—including provider host systems, payer portals, and internal administrative tools—while upholding the highest standards of data privacy and system interoperability.Nick Frosst, Co-Founder of Cohere, remarked, “Working with Ensemble to bring secure AI into healthcare—where data privacy is a deeply personal issue—is an incredible opportunity. By working together, we’re setting a new standard for tackling some of healthcare’s toughest administrative challenges and showing how agentic AI makes a real-world difference.”
Cincinnati, OH, Oct. 16, 2024 (GLOBE NEWSWIRE) -- Ensemble, the partner of choice for end-to-end revenue cycle management for mid-sized to large healthcare organizations, has been named a Leader in Everest Group’s RCM Operations PEAK Matrix® Assessment 2024. According to the assessment, Ensemble is the highest-designated leader for market impact reflecting not only the strength of its vision, expertise and approach to technology, but the unmatched value delivered at scale to a rapidly growing and highly satisfied client base. “This latest recognition validates our commitment to client satisfaction, delivering a frictionless revenue cycle and providing significant value for leading healthcare systems across the country,” said Ensemble Founder, President and CEO Judson Ivy. “The healthcare revenue cycle is growing increasingly more complex due to changing regulations, reimbursement requirements and rapid shifts in payer policy. We are proud to be recognized as a leader for our excellence in improving financial outcomes and patient experiences so providers can hyper-focus on delivering high-quality care to their patients and communities.” According to Everest Group, Ensemble’s strengths include value delivered, vision and strategy, innovation and investments and scope of services offered
Cincinnati, OH, Oct. 03, 2024 (GLOBE NEWSWIRE) - Ensemble, the market leader in revenue cycle management for mid-sized to large healthcare organizations, announced today that is has been selected by Mary Washington Healthcare (MWHC) as their strategic revenue cycle management partner.