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The University of Michigan
Outpatient Coding Denial and Appeals Specialist
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What they do
A Medical Coder organizes and reviews patient medical records and assigns codes for each diagnosis and treatment. Prepares coded information for use by health care insurers or for research. May retrieve information for clinicians and billing offices. Works in healthcare facilities.
$62,245 / year median in Michigan
-12% projected decline
Job Description
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. Denial/Audit AnalysisReview 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 AccuracyEnsure 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 ReviewCollaborate with clinical documentation specialists to ensure the completeness and accuracy of patient records to support coding and billing processes.
AppealsPrepare and submit appeals for denied claims, providing necessary documentation and supporting evidence to maximize reimbursement.
Regulatory ComplianceStay updated with coding and billing regulations, including changes to Medicare, Medicaid and commercial payer policies to ensure compliance.
Coding SoftwareUtilize the electronic health record (EHR) and coding software proficiently to facilitate accurate coding and billing processes.
Metrics and ReportingMaintain records of denials trends, appeals outcomes, and revenue recovery statistics, and provide regular reports to management.
Customer ServiceCommunicate professionally and effectively with patients, healthcare providers, and internal/external stakeholders to resolve denial-related inquiries and issues.
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 requirementsMichigan 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.
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.
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.
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.
Rectify identified coding issues using proper documentation and evidence for code changes or corrections to support timely revenue.
Coding AccuracyEnsure 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 ReviewCollaborate with clinical documentation specialists to ensure the completeness and accuracy of patient records to support coding and billing processes.
AppealsPrepare and submit appeals for denied claims, providing necessary documentation and supporting evidence to maximize reimbursement.
Regulatory ComplianceStay updated with coding and billing regulations, including changes to Medicare, Medicaid and commercial payer policies to ensure compliance.
Coding SoftwareUtilize the electronic health record (EHR) and coding software proficiently to facilitate accurate coding and billing processes.
Metrics and ReportingMaintain records of denials trends, appeals outcomes, and revenue recovery statistics, and provide regular reports to management.
Customer ServiceCommunicate professionally and effectively with patients, healthcare providers, and internal/external stakeholders to resolve denial-related inquiries and issues.
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 requirementsMichigan 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.
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.
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.
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.