Job Summary
The Denials Prevention and Appeals Specialist is responsible for ensuring the accuracy and integrity of coding and billing processes within Michigan Medicine. This position plays a pivotal role in revenue cycle management by developing and executing robust denials prevention programs, conducting regular audits, and offering continuous training to staff. The specialist ensures compliance with all relevant regulations and contributes to the financial health of the organization by proactively addressing and preventing coding discrepancies.
Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Responsibilities*
Characteristic Duties and Responsibilities:
- Audit and Denial Analysis:
- Training and Development:
- Coding and Compliance:
- Collaboration and Communication:
- Regulatory Monitoring:
- Reporting and Improvement:
Required Qualifications*
- CCS, RHIT, or RHIA coding certification required; certification as an RN is also acceptable.
- Minimum of three years of inpatient coding experience or equivalent experience as a clinical documentation specialist.
Desired Qualifications*
- Proven experience in training and educational program development preferred.
- Extensive knowledge of ICD-10 coding guidelines and clinical criteria for disease processes.
- Familiarity with inpatient reimbursement methodologies and denials management.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills, with a focus on customer service.
- Proficiency in EHR and coding software applications.
- Self-motivated and capable of working independently with attention to detail.
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
Background Screening
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO Statement
The University of Michigan is an equal employment opportunity employer.