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

Sparrow Health System

Ospedali, cliniche, personale non medico

Lansing, MI - USA

Manager / Team Leader

Experteer Overview

In this role you lead the audits, appeals, and denials avoidance efforts at University of Michigan Health-Sparrow. You will oversee denials analysis, appeal generation, and managed care contract review to drive favorable outcomes and compliance. You’ll manage a team, coordinate with payers and government agencies, and lead process improvements to reduce denials and optimize revenue. This position sits at the center of cross-functional collaboration, addressing root causes and implementing system enhancements. You will help shape a proactive, data-driven denials program with a focus on patient access, compliance, and operational excellence.

Responsabilità

Lead hospital billing audit, appeals, and denial resolution processes leveraging medical necessity reviews and regulator requirements
Develop and implement operational objectives and performance targets aligned with departmental goals
Supervise Appeals Specialists and Denial Resolution staff, including hiring, training, and performance management
Oversee creation of appeal letters to maximize favorable outcomes and manage work queues, resolutions, escalations, and reporting
Liaise with third-party payers and government agencies (e.g., RAC, MAC, CMS)
Foster internal and external relationships with payer representatives, physicians, and revenue cycle teams
Participate in Lean initiatives and serve as primary liaison for denials and appeals
Analyze denials and audit results to identify root causes and mitigation strategies
Analyze audit outcomes, drive corrective actions, and recommend system enhancements
Lead Technical Denials team meetings and process improvements
Ensure HIPAA and UMH Sparrow privacy and compliance standards are maintained

Requisiti fondamentali

CPC, CCS, CPMA, RHIT or CHFP preferred
Experience in utilization management, hospital billing, or third-party claims adjudication
Proven healthcare appeals experience
2–5 years leadership/management experience preferred
Understanding of hospital and physician billing and payer processes
Strong interpersonal, presentation, written communication, problem-solving, and decision-making skills
Bachelor's Degree in Finance, Accounting, Business Administration, Healthcare Administration or related field with 5+ years of Revenue Cycle experience; OR Associate's Degree with 5+ years of Revenue Cycle experience and 2+ years of leadership; OR High School Diploma with 6+ years of Revenue Cycle experience and 3+ years leadership

strong communication leadership problem-solving payer reimbursement methodologies billing compliance rules HIPAA/privacy standards

Descrizione della posizione

In this role you lead the audits, appeals, and denials avoidance efforts at University of Michigan Health-Sparrow. You will oversee denials …

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