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. #LI-MA1
Job Family
Administrative/Clerical
Requirements:
| Shift |
Days |
| Degree Type / Education Level |
High School / GED |
| Status |
Full-time |
| Facility |
Sparrow Hospital |
| Experience Level |
New Grad |
|
Sparrow Health System
Mar 27, 2026