Job Opportunity
Job ID:50636 Positions Location: Lansing, MI Job Description General Purpose of
Description:
Positions Location: Lansing, MI
Job Description
| General Purpose of Job: Implement/maintain a coding quality review system for inpatient coders within the Regional Health System to assure appropriateness, accuracy and compliance for ICD-10-CM/PCS code assignments, DRG grouping, Present on Admission (POA) indicators, Severity of Illness (SOI) and Risk of Mortality (ROM) in accordance with CMS guidelines and AHA Official ICD-10 Coding Guidelines. Provide education to all staff within the CDI/Coding unit within Revenue Cycle. Denials and Appeals play 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. Responsible for reviewing and resolving denials related to inpatient services by evaluating and rectifying coding errors and ensuring compliance with healthcare regulations. This role corrects ICD-10 CM and PCS 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 |
| 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.
- Develops, implements, and monitors chart review system for inpatient coders.
- Performs chart reviews across multiple service lines utilizing appropriate coding references and guidelines.
- Designs, implements, and conducts effective training programs to support the Regional inpatient coding team within revenue cycle.
- Partners with CDI for documentation needed for quality initiative programs.
- Communicates opportunities for improved workflow to information technology and/or EPIC analysts
- Identifies and implements coding opportunities to maximize reimbursement.
- Maintains standardized compliance with Sparrow compliance policies.
- Denial/Audit Analysis: Review and analyze denied inpatient 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.
- Appeals: Prepare and submit appeals for denied claims, providing necessary documentation and supporting evidence to maximize reimbursement, severity of illness/risk of mortality, and coding accuracy.
- Other projects as assigned.
|
Job Requirements
| General Requirements |
* Certification as an RHIT or CCS through the American Health Information Management Association. * RHIA - preferred |
| Work Experience |
* Minimum of 3 years relevant coding experience |
| Education |
* Associate's degree in HIM or relevant healthcare field * Bachelor's degree - preferred |
| Specialized Knowledge and Skills |
* Extensive knowledge of ICD-10 coding principles and guidelines, DRG process, POA, SOI and ROM scoring * Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing. * Knowledge of ICD-10 coding and current rules /regulations regarding reimbursement and billing compliance * This position requires strong coding expertise, analytical skills, and a deep understanding of healthcare reimbursement processes. * Excellent organizational, communication, and interpersonal skills. * Knowledge of Microsoft Word, Excel, and Internet applications. * Optum and/or 3M encoder experience - preferred |
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.
Job Family
Administrative/Clerical
Requirements:
| Shift |
Days |
| Degree Type / Education Level |
Associate |
| Status |
Full-time |
| Facility |
Sparrow Hospital |
| Experience Level |
New Grad |
|
Sparrow Health System
Sep 12, 2025