Claims Edit Coder Jobs in Michigan (NOW HIRING)

We are seeking an experienced Revenue Cycle Management (RCM) Manager to support our diagnostic laboratory specializing in women’s health, toxicology, and genetic testing. This role is responsible for overseeing both pre-submission and post-submission revenue cycle activities, including claim readiness, coding and documentation review, clearinghouse rejection prevention, denial management, accounts receivable follow-up, reimbursement recovery, and revenue cycle trend analysis.

The RCM Manager will work closely with the RCM Director and cross-functional departments to identify operational, billing, coding, payer, and workflow issues that negatively impact clean claim submission, claim acceptance, reimbursement timelines, denial rates, AR performance, and overall cash collections. This role will determine root causes, recommend corrective actions, support implementation of process improvements, and monitor the effectiveness of workflow changes over time.

Core Responsibilities

Revenue Cycle Oversight, Trend Analysis & Root Cause Identification

· Monitor and analyze revenue cycle performance metrics across both pre-submission and post-submission workflows to identify trends causing claim delays, clearinghouse rejections, denials, underpayments, aging AR, delayed payments, or reimbursement slowdowns.

· Identify recurring issues across departments, payers, CPT codes, diagnosis coding, providers, facilities, payer edits, documentation requirements, authorization workflows, and operational workflow stages.

· Conduct root cause analysis on issues impacting clean claim rates, claim acceptance, denial rates, turnaround times, reimbursement recovery, and cash collections.

· Track and trend payer behaviors, including medical necessity denials, prior authorization issues, coding discrepancies, bundling edits, frequency limitations, documentation requests, and reimbursement delays.

Pre-Submission Claim Review, Scrubbing & Coding Compliance

· Review and scrub claims prior to submission to ensure all patient, provider, CPT, HCPCS, modifier, diagnosis, eligibility, authorization, and documentation information is accurate and complete.

· Validate CPT and ICD-10 coding for medical necessity and payer compliance in accordance with CMS, LCD/NCD, and commercial payer guidelines.

· Identify claim discrepancies, missing documentation, payer edit concerns, coding gaps, or workflow failures and coordinate resolution efforts with internal and external stakeholders.

· Support improvements that increase clean claim rates, reduce clearinghouse rejections, and shorten pre-submission turnaround times.

Post-Submission Denial Management, Appeals & AR Recovery

· Monitor submitted claims and accounts receivable to identify trends related to denials, delayed payments, underpayments, aging AR, payer correspondence, EOBs/ERAs, and reimbursement slowdowns.

· Analyze denial codes, remittance data, payer correspondence, and EOBs/ERAs to determine root causes, financial impact, and recovery opportunities.

· Initiate, manage, and track appeals, reconsiderations, corrected claims, and escalation workflows to maximize reimbursement recovery.

· Perform detailed AR follow-up activities to ensure timely payer responses, appropriate claim resolution, and reduction of unresolved aging balances.

· Communicate directly with payers, clearinghouses, and internal teams regarding claim status, billing discrepancies, appeal needs, documentation requests, and reimbursement delays.

· Maintain accurate documentation, payer notes, appeal tracking, and follow-up logs within billing and RCM systems.

· Ensure unresolved claims are escalated appropriately based on aging, financial impact, payer responsiveness, or operational risk.

Corrective Action, Process Improvement & Workflow Implementation

· Develop actionable recommendations and corrective workflows to reduce claim delays, denials, underpayments, reimbursement slowdowns, and preventable AR accumulation.

· Present trends, root cause findings, recovery opportunities, financial impact, and operational recommendations to the RCM Director and leadership team on a consistent basis.

· Assist with implementing approved process improvements into existing departmental workflows and SOPs.

· Work collaboratively with operational, clinical, billing, coding, and leadership teams to ensure corrective actions are adopted, maintained, and measured for effectiveness.

· Support leadership in identifying opportunities to reduce Days Sales Outstanding (DSO), improve cash collections, and strengthen end-to-end revenue cycle performance.

· Other duties as assigned.

Reporting & Operational Insights

Prepare weekly and monthly reporting for the RCM Director outlining key performance trends and operational insights, including:

· Clean claim performance and pre-submission issue trends

· Denial trends and root cause findings

· AR aging performance

· Recovery rates and appeal outcomes

· High-impact payer issues

· Coding, authorization, documentation, and workflow inefficiencies

· Recommended corrective actions

· Status updates on implemented improvements

· Measured effectiveness of workflow changes and operational improvements over time

Qualifications

· 2+ years of experience in Revenue Cycle Management, medical billing, claims analysis, coding, denial management, AR follow-up, or reimbursement recovery; laboratory or diagnostic testing experience strongly preferred.

· Strong understanding of CPT, ICD-10, HCPCS, modifiers, EOB/ERA interpretation, payer billing requirements, denial resolution workflows, appeals, and reimbursement recovery.

· Working knowledge of CMS regulations, LCD/NCD policies, prior authorization workflows, commercial payer billing rules, medical necessity requirements, and payer-specific billing requirements.

· Experience analyzing denials, reimbursement trends, AR performance, claim acceptance issues, and operational workflow inefficiencies.

· Familiarity with claim scrubbing software, billing systems, EHRs, clearinghouses, payer portals, laboratory billing workflows, and RCM reporting dashboards.

· Experience collaborating across multiple operational, clinical, billing, coding, and leadership teams.

· Certification such as CPC, COC, CRCR, or equivalent preferred but not required.

Personal Skills

· Strong analytical and problem-solving mindset with the ability to identify reimbursement trends, operational patterns, and workflow bottlenecks.

· Highly detail-oriented with strong organizational, documentation, and follow-through capabilities.

· Excellent written and verbal communication skills, including the ability to present findings clearly and manage payer correspondence and escalation activities effectively.

· Ability to manage multiple priorities and drive measurable process improvements in a fast-paced environment.

· Self-motivated, proactive, persistent, resourceful, and solution-oriented.

· Comfortable working independently while collaborating across departments and leadership teams.