Ensemble Health Partners

Auditor

• Perform documentation and coding audits for all acute inpatient services for clients
• Identify coding errors, compliance, and educational opportunities
• Optimize reimbursement by ensuring that diagnosis/procedure codes and supporting documentation accurately support the services rendered
• Perform independent reviews, interpret medical records, and apply in-depth knowledge of coding principles
• Conduct DRG (ex. MS, APR, Tricare) coding and clinical reviews
• Maintain productivity and quality goals as set by audit leaders
• Write clear, accurate and concise recommendations
• Ensure acute inpatient coding audits are completed accurately and timely

DRG Validation Coding Auditor

Financial Planning and Analysis

• Provide personalized guidance to help patients understand and manage healthcare-related financial obligations
• Review benefits, estimate out-of-pocket costs, and facilitate payment arrangements
• Address billing and coverage inquiries and maintain accurate account documentation
• Monitor trends, prepare operational reports, and support process improvement initiatives

Senior Financial Navigating Specialist

Billing Specialist

• Performs all billing, correspondence, and scanning activities across the organization
• Managing client billing and ensuring procedures are billed according to contracts
• Reviewing and updating client statements as necessary
• Printing and mailing all paper and secondary claims
• Scanning documents to patient accounts
• Reviewing correspondence and following up as needed
• Meeting the mission and goals of the organization
• Meeting the regulatory compliance requirements

Physician Billing Associate Specialist

Engineer

• Responsible for system integration, data ingestion, transformation, validation, and maintenance
• Design, build, and support HL7 interfaces using the Infor Cloverleaf Interface Engine
• Develop and implement HL7/EDI interfaces and REST APIs
• Perform workflow analysis and documentation
• Interact with multi-disciplinary teams and communicate effectively

Data Engineer

IT Support

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or location Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to ensure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities, initializing and coordinating the application process to facilitate accurate and appropriate submissions.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.

Public Benefit Specialist

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to ensure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities, initializing and coordinating the application process.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.

• Interview uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
• Assist with application processes to facilitate accurate and appropriate submissions.
• Follow-up on submitted applications to ensure timely billing or adjustment processing.
• Review all referred uninsured/under-insured patients for program eligibility opportunities.
• Communicate effectively with the patient to obtain documents that must accompany the application.
• Maintain working knowledge of all state and federal program requirements; share information with colleagues and supervisors.
• Develop and maintain proactive working relationships with county/state/federal Medicaid caseworker partners.

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or location Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to insure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities, initializing and coordinating the application process to facilitate accurate and appropriate submissions.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; shares information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners, working collaboratively with other revenue cycle departments and associates.
• Other job duties as assigned.

Director

• Build strong, trusted relationships with clients and serve as a strategic partner
• Develop a deep understanding of client KPIs and SLAs within the first 60 days
• Identify and execute proactive opportunities to improve performance, satisfaction, and outcomes
• Oversee complex multi-client utilization review and utilization management operations
• Drive measurable improvements in performance, productivity, and SLA attainment
• Lead data-driven decision-making using dashboards and analytics tools
• Champion adoption of new technologies and investment capabilities
• Lead large-scale change initiatives across people, process, and technology
• Partner cross-functionally to implement process and system improvements
• Lead, develop, and mentor a large, multi-layered team (125–175 employees globally)
• Manage and empower direct reports (minimum of 3 leaders)
• Foster a high-performing culture aligned with organizational values

Director, Virtual Utilization Review

Full-stack Engineer

• evangelize, influence and implement the technology strategy for Ensemble software delivery teams
• focus on the biggest needs across the organization and develop reusable components, patterns, and tooling to address them
• influence behaviors through code reviews and hands on design sessions
• actively mentor the engineering team through code reviews, and hands on design sessions
• responsible for the team's technical deliverables and the quality of it.
• responsible for designing the solutions in alignment with the future state architecture for the features to be delivered

Lead Engineer, Software

• Design, develop, test, deploy, monitor, and continuously improve backend services and APIs supporting data-driven applications
• Build and maintain scalable data pipelines and services that enable ingestion, transformation, and delivery of structured data for user consumption
• Develop reusable components, frameworks, and tooling that support consistent and scalable data processing and decisioning workflows
• Collaborate with product, analytics, and design teams to translate business requirements into technical solutions that improve visibility and usability of data
• Partner with architecture and data teams to ensure accurate, reliable, and high-quality data integration between systems
• Participate in and lead technical design sessions, architecture reviews, and exploratory investigations to align with long-term platform strategy
• Implement and advocate for engineering best practices related to performance, scalability, security, observability, and maintainability
• Support development of user-facing data capabilities, including visualization, filtering, and interaction with structured datasets
• Mentor and guide engineers through code reviews and collaboration, helping to elevate team capability and technical standards
• Contribute to an innovation-focused environment by leveraging automation, AI-enabled tools, and advanced data capabilities

Senior Engineer, Software

Insurance

• Support the Insurance Authorization Specialist I staff in their responsibility for selecting accurate medical records for patient safety
• Obtain and validate demographic and insurance information
• Work with insurance companies and/or physician offices to complete insurance authorization requirements to secure payment
• Assist the supervisor with escalated issues
• Track system and process issues
• Assist in the training and mentoring of new hires
• Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements
• Be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated
• Perform other duties as assigned

Senior Insurance Authorization Specialist

Vice President

• Executes enterprise utilization management strategy aligned with organizational and regulatory requirements
• Oversees operations including prior authorization, medical necessity review, and concurrent review processes
• Ensures compliance with CMS, payer, and state regulatory requirements
• Identifies and mitigates audit, compliance, and reimbursement risks
• Monitors performance metrics including denial trends and utilization efficiency
• Drives performance improvement initiatives based on data analysis
• Collaborates with clinical, case management, and revenue cycle teams to improve documentation and reduce denials
• Supports implementation and optimization of utilization management technologies and workflows
• Leads and develops managers and operational leaders
• Supports succession planning and organizational capability development
• May be required to perform other job-related duties as requested.

AVP, Utilization Management

Counselor

• Performs benefit education and validation
• Handles verification and calculation of patient liabilities including previous balances and collection of patient payments
• Makes at least 3 attempts each day to visit a patient's room
• Completion of pre-registration and registration tasks
• Assists eligibility specialists in the verification of insurance information

Financial Counseling Specialist

• Responsible for the assessment and collection of patient liabilities.
• These collections include copays, deductibles, co-insurance and balances after financial assistance.
• This individual is tasked with assessing patient insurance and financial information to determine liability.
• The Specialist in Inpatient Collections will utilize face to face communication with patients during their stay to collect the estimated patient liability.
• Works various patient access, insurance eligibility, follow-up reports as assigned.
• Assists in facilitating daily inhouse call reviews to include all needed parties to validate that patients have a valid payor source with authorization on the account for the current stay.
• Completion of pre-registration and registration tasks including, but not limited to, the registration of patients at the time of service, or prior to the date of service while attempting to collect the patient’s financial liability.
• Monitors missed collection opportunities for potential process improvements and follow-up.
• Must make at least 3 attempts each day to visit a patient's room if the patient is otherwise preoccupied in previous attempts.
• Notes all accounts with a patient liability daily.
• Makes follow-up phone calls to patients that are unable to make payment while in-house.
• Sends letters to patients' addresses post-discharge detailing an estimated liability as well as options to pay.
• Works with patients to sign consent to treat, observation, Important Message from Medicare, and other registration-related forms if applicable.
• Assists eligibility specialists in the verification of insurance information, Medicaid and charity processing, and other tasks as needed.
• Runs a daily census to determine patients with potential eligibility.
• Assists in the collection and organization of outpatient orders as they relate to future and current dates of service, utilizing queues built within various Revenue Cycle systems.