Revenue Cycle: Denials & Appeals Specialist

Oamichigan; Grand Rapids (MI); On-site; USD 42,000 - 58,000; Full time

Job summary

Orthopaedic Associates of Michigan (OAM) is seeking a Claims Denial & Appeals Specialist in Grand Rapids, MI. The role focuses on reviewing denials, preparing appeals, and improving reimbursement outcomes within a collaborative revenue cycle team.

Office hours are full-time, with standard Mon-Fri scheduling. The position emphasizes HIPAA compliance, payer communications, and accurate account documentation to support high-quality patient care.

Qualifications

• Minimum 1 year in medical billing or related healthcare office function.
• Knowledge of CPT, ICD-10-CM, HCPCS and modifiers.
• HIPAA confidentiality knowledge and practice.
• Experience with payer reimbursement methodologies.

Responsibilities

• Review denied or underpaid insurance claims and determine appeal actions.
• Prepare supporting documentation for claim appeals.
• Communicate with payers about denial and reimbursement issues.
• Resubmit denied or corrected claims for proper reimbursement.
• Audit patient accounts for payments, balances, and coding accuracy.
• Identify denial trends and suggest process improvements.
• Coordinate with the Business Office for AR reconciliation.
• Provide financial counseling and assist with payment arrangements.

Skills

Communication skills

Customer service

MS Office

Analytical thinking

Multitasking

Time management

Interpersonal skills

Confidentiality/HIPAA

Payer guidelines

Adaptability

Education

High school diploma or GED

Healthcare revenue cycle coursework

Tools

Computerized patient accounting

Payer portal management

Electronic remittance processing

Medical billing software

Job description

Orthopaedic Associates of Michigan (OAM) is seeking a Claims Denial & Appeals Specialist in Grand Rapids, MI. The role focuses on reviewing denials, preparing appeals, and improving reimbursement outcomes within a collaborative revenue cycle team.

Office hours are full-time, with standard Mon-Fri scheduling. The position emphasizes HIPAA compliance, payer communications, and accurate account documentation to support high-quality patient care.