Outpatient Coding Denial and Appeals Specialist

Outpatient Coding Denials Specialist

The Outpatient Coding Denials Specialist plays a vital role in the revenue cycle management of Rev Cycle Mid-Service by maintaining the financial integrity of the healthcare facility and ensuring adherence to regulatory requirements. They are responsible for reviewing and resolving denials related to outpatient professional/facility services by evaluating and rectifying coding errors and ensuring compliance with healthcare regulations. This role corrects CPT coding discrepancies to ensure accurate and compliant billing and reimbursement. Collaborates with and assists internal stakeholders to support code accuracy on pre-bill and post-billed accounts. This position requires strong coding expertise, analytical skills, and a deep understanding of healthcare reimbursement processes.

Responsibilities

• Denial/Audit Analysis
• Review and analyze denied outpatient claims and external audit opportunities to identify the root causes, including coding errors, missing documentation, and other issues.
• Rectify identified coding issues using proper documentation and evidence for code changes or corrections to support timely revenue.
• Coding Accuracy
• Ensure accurate coding for outpatient procedures, diagnoses, and services in compliance with current ICD-10-CM, CPT, and HCPCS coding guidelines.
• Collaborate with Medical Coder Compliance Specialist on coder error trends to remedy coder education efforts.
• Documentation Review
• Collaborate with clinical documentation specialists to ensure the completeness and accuracy of patient records to support coding and billing processes.
• Appeals
• Prepare and submit appeals for denied claims, providing necessary documentation and supporting evidence to maximize reimbursement.
• Regulatory Compliance
• Stay updated with coding and billing regulations, including changes to Medicare, Medicaid and commercial payer policies to ensure compliance.
• Coding Software
• Utilize the electronic health record (EHR) and coding software proficiently to facilitate accurate coding and billing processes.
• Metrics and Reporting
• Maintain records of denials trends, appeals outcomes, and revenue recovery statistics, and provide regular reports to management.
• Customer Service
• Communicate professionally and effectively with patients, healthcare providers, and internal/external stakeholders to resolve denial-related inquiries and issues.

Required Qualifications

One of the following certifications:

• Certified Professional Coder (CPC) coding certification.
• Clinical Coding Specialist (CCS) and registration with the American Health Information Management Association.
• Associates Degree in Health Information Technology and registration with the American Health Information Management Association as a RHIT or RHIA.
• Minimum of 3 years of outpatient coding experience.
• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines.
• Familiarity with outpatient reimbursement methodologies.
• Proficiency in using EHR and coding software.
• Excellent analytical and problem-solving skills.
• Strong communication and interpersonal skills.
• Attention to detail and ability to work independently.
• Knowledge of healthcare regulations and compliance requirements

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

• Excellent medical, dental and vision coverage effective on your very first day
• 2:1 Match on retirement savings

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 any time after the minimum posting period has ended.

U-M EEO Statement

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.