Manager, Centralized Audits and Appeals
The Manager, Audits and Appeals provides strategic and operational leadership for the health system's centralized audits and appeals program. This position directs a multidisciplinary team responsible for payer audits, denials management, medical necessity reviews, high-cost outlier forensic audits, government and commercial payer appeals, and audit response operations. The manager applies advanced clinical knowledge, utilization management principles, reimbursement expertise, and regulatory interpretation to mitigate organizational financial risk, optimize reimbursement outcomes, and ensure regulatory compliance.
This role serves as the organization's subject matter expert for complex audit and appeal activities and partners closely with Clinical Documentation Integrity, Utilization Management, Revenue Cycle, Coding, Patient Financial Services, Compliance, and physician leadership to develop proactive denial prevention strategies and strengthen revenue integrity performance.
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.
This position is not eligible for University sponsorship for employment authorization now or in the future.
Position Responsibilities:
Lead and oversee all audit and appeal operations within the centralized audit program, including external payer audits, internal audits, forensic reviews, and release of information.
Establish program metrics, dashboards, metric reporting cadence, and performance standards for all audit and appeal activities in partnership with Revenue Integrity Leadership.
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 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:
Bachelor’s degree in business, finance, or clinical field, OR an equivalent combination of education and experience.
Experience with Epic Patient Accounting System
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
2 years demonstrated experience conducting complex financial, reimbursement, audit, and denial analyses, with the ability to quantify net revenue impact, assess associated regulatory and quality risks, and effectively communicate findings and recommendations to departmental leadership, executive stakeholders, payer relations teams, and external payer representatives.
Working knowledge and 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
Advanced experience performing complex audit, reimbursement, and financial analyses to identify revenue opportunities, assess risk, and quantify net reimbursement impact.
Proven ability to present complex analytical findings and strategic recommendations to leadership and internal and external stakeholders.
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 upload a 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 of 7 calendar 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 sharon-walther@uiowa.edu.
Equal opportunity employer
The University of Iowa is an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment free from discrimination on the basis of race, creed, color, religion, national origin, age, sex, pregnancy (including childbirth and related conditions), disability, genetic information, status as a U.S. veteran, service in the U.S. military, sexual orientation, or associational preferences.
Persons with disabilities who need assistance or accommodations with the application or interview process may contact University Human Resources/Faculty and Staff Disability Services, (319) 335-2660 or fsds@uiowa.edu. For jobs in UI Health care, please contact UI Health care Leave & Disability Administration at 319-356-7543.
