Manager, Audits and Appeals

University of Iowa•Iowa City, IA

13h•Hybrid

About The Position

The Manager of Revenue Integrity – Audits and Appeals leads the operational, strategic, and analytical functions of the audit and appeal program within UI Health Care’s Finance and Accounting Revenue Integrity Division. This role is responsible for high-risk and high-dollar audit activity, including high-cost outlier forensic audits, as well as oversight of diversified audit activity for the Medical Center Downtown campus. The manager ensures compliant, timely, and effective audit responses; drives denial mitigation and appeal success; and leverages data to monitor, analyze, and communicate key performance indicators (KPIs) to stakeholders.

Requirements

Bachelor’s 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.

Nice To Haves

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

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.