UMH Sparrow Health System - Manager of Denials, Audits & Appeals

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.

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Job Family
Administrative/Clerical
Requirements:

Shift
Days

Degree Type / Education Level
High School / GED

Status
Full-time

Facility
Sparrow Hospital

Experience Level
New Grad