Job Description
Job Opportunity Job ID: 53472 Description: Positions Location: Lansing, MI Job Description General Purpose of Job : Provide leadership and direction for University of Michigan Health-Sparrow’s audit, appeals, and denials avoidance functions. Areas of focus will include denials analysis, denial write offs, appeals management, analysis of managed care contracts, and other clinically related denial issues. Essential Duties This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position. Lead hospital billing audit and appeals and denial resolution processes, leveraging expertise in medical necessity reviews, payer requirements, appeal criteria, and regulatory compliance. Develop and implement operational objectives, establish performance targets, and ensure policies support departmental goals. Foster a collaborative and values-driven culture. Oversee the creation of appeal letters to maximize favorable outcomes; manage work queues, resolutions, escalations, and results reporting. Liaise with third-party payers and government agencies (e.g., RAC: Recovery Audit Contractors; MAC: Medicare Administrative Contractors; CMS: Centers for Medicare & Medicaid Services). Supervise and coach Appeals Specialists and Denial Resolution staff, including performance management, hiring, training, and development. Support strong internal and external relationships with payer representatives, physicians, and revenue cycle teams. Participate in committee work and Lean initiatives; serve as primary liaison for denials and appeals across the organization. Analyze denials and audit results to identify root cause and develop mitigation strategies. Analyze audit outcomes, initiate corrective actions, and recommend system enhancements. Lead Technical Denials team meetings and process improvements. Ensure compliance with HIPAA and UMH Sparrow privacy and compliance standards. Job Requirements General Requirements Certifications such as CPC, CCS, CPMA, RHIT or CHFP are preferred. Work Experience See Education Experience in utilization management, care management, hospital billing, or third-party claims adjudication. Proven experience with healthcare appeals. Leadership and team motivation skills. Ability to work independently and as part of a team, with prior management experience. Understanding of hospital and physician billing, third-party payer processes, and accreditation requirements. Strong interpersonal, presentation, written communication, problem-solving, and decision-making skills. 2-5 years recent experience in utilization management, appeals, or case management preferred Education Bachelor's Degree in Finance, Accounting, Business Administration, Healthcare Administration or related field and minimum 5 years of experience in Revenue Cycle environments; OR Associates Degree in Finance, Accounting, Business Administration, Healthcare Administration or related field and minimum 5 years of experience in Revenue Cycle environments and minimum 2 years leadership experience; OR High School Diploma/GED and minimum 6 years of experience in Revenue Cycle environments and minimum 3 years leadership experience Specialized Knowledge and Skills Detailed knowledge of payer reimbursement methodologies and billing compliance rules. Ability to plan, organize, coordinate, direct and lead. Excellent communication skills (written, verbal, and listening). University of Michigan Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status. Requirements Job Family Administrative/Clerical Requirements: Shift Days Degree Type / Education Level High School / GED Status Full-time Facility Sparrow Hospital Experience Level New Grad