RN Clinical Appeals

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy.

About the role

The RN Clinical Appeals performs all appeals for clinically related claim denials across Ensemble Health Partners, or in a role that primarily assists with analyzing and reviewing records to prevent future denials, provide clinical records to payers, and prepare for provider-to-provider (P2P) reviews.

• Contact insurance plans to determine reasons claims were denied
• Analyze claims and determine if appeal is necessary
• Prepare appeal materials, which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records
• Act as a liaison between healthcare providers for any additional medical documentation or clarification
• Submit appeals in a timely manner
• Work closely with other departments (Case Management, HIM, Physician Advisory, Clinical Denials, Denial Prevention, Accounts Receivable, Bedded Inpatient Authorization, and Virtual Utilization review) to ensure denial trends and outcomes are communicated in a timely manner

This position pays between $56,800.00 – $108,900.00 based on experience.

Requirements

• Current unrestricted license to practice nursing (LPN, RN)
• CRCR or other approved professional certification required within 9 months of hire
• 1 to 3 years of job experience
• Associates Degree or equivalent experience; Bachelor’s Degree preferred
• 2 years of denials, utilization review, or case management experience strongly preferred
• Proficient computer skills, including Microsoft Suite
• Experience in hospital operations, chart audit/review, and provider relations
• Demonstrated advanced usage of AI and management of teams using AI for process and technological improvements

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 package (healthcare, time off, retirement, and well-being programs)
• Professional development and certification opportunities
• Quarterly and annual incentive programs
• Collaborative, growth-focused culture

Company Recognition

• Five-time winner of “Best in KLAS” (2020-2022, 2024-2025)
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution (2021-2024)
• 22 HFMA MAP Awards for High Performance in Revenue Cycle (2019-2024)
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment (2024)
• Clarivate HBI Revenue Cycle Awards for strong performance (2020, 2022-2023)
• Energage Top Workplaces USA (2022-2024)
• Fortune Media Best Workplaces in Healthcare (2024)
• Monster Top Workplace for Remote Work (2024)
• Great Place to Work certified (2023-2024)