Manager, Audits and Appeals
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Job Summary
Financial Oversight and Budgeting Responsibilities:
Lead and oversee all audit and appeal operations including external payer audits internal audits forensic reviews and release of information.
Develop and execute denial and appeal strategies to optimize reimbursement and minimize revenue loss.
Monitor trend and report audit and denial KPIs such as overturn rates audit accuracy financial impact and response timeliness.
Translate audit data into actionable insights and present findings to leadership and stakeholders.
Collaborate with Patient Financial Services HIM/Coding Compliance and clinical teams to resolve audit issues and prevent recurrence.
Ensure compliance with federal regulations payer requirements and internal policies Establish and refine audit workflows policies and controls to strengthen audit readiness and response.
Lead continuous improvement initiatives focused on denial prevention and revenue integrity optimization.
Manage mentor and develop audit and appeal staff including performance management and training.
Serve as subject matter expert on audit and appeal processes and regulatory changes.
Serve as the primary point of contact for audit tracking software and associated tasks.
Required Qualifications:
Bachelors degree in business finance or clinical field OR an equivalent combination of education and experience.
5 years of experience with professional and facility revenue cycle operations.
2 years of supervisory experience
2 years of experience with clinical and administrative/technical denials and appeals
Experience with Epic Patient Accounting System
Experience with complex financial analysis and presentation.
Reasonable knowledge of claims payment methodologies for both physician and hospital reimbursement (ex. fee schedule APR-DRG EAPG APC per diems etc.)
Understanding of CPT-4 and ICD-10 coding.
Ability to manage large complex projects simultaneously.
Excellent written and verbal communication skills.
Demonstrated proficiency in Microsoft Office applications.
Advanced experience using Microsoft Excel.
Demonstrated experience working effectively in a welcoming and respectful workplace environment.
Desired qualifications:
Masters degree preferred (clinical or administration)
Experience with clinical and administrative/technical denials and appeals specific to audits
Experience with medical coding and/or CPC Certification (or similar).
Nursing or clinical background.
Familiarity or experience with Epic clinical and/or administrative application build
Application Process:To be considered applicants must uploada cover letter and resume(under the submission of relevant materials)that clearly address how they meet the listed required and desired qualifications of this position. Job openings are posted for a minimum of7calendar days. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification.
Up to 5 professional references will be requested at a later step in the recruitment process. For questions contact Sharon Walther at.
This position is not eligible for University sponsorship for employment authorization now or in the future.
This position is eligible for hybrid work within Iowa and will require a work arrangement form to be completed upon the start of your employment. Per policy work arrangements will be reviewed annually and must comply with the remote work program and related policies and employee travel policy when working at a remote location.
Required Experience:
Manager
About Company
The University of Iowa is a top-tier public research university in Iowa City—home to more than 32,000 students, offering world-class programs across 200+ fields of study, renowned especially for its creative writing, acclaimed medical center, and balanced excellence in the arts and sc ... View more
