Manager, Centralized Audits and Appeals

The University of Iowa; Iowa City (IA); Hybrid; USD 110,000 - 160,000; Full time

Job summary

The University of Iowa seeks a Manager, Audits and Appeals to lead the centralized audits and appeals program. You will direct a multidisciplinary team handling payer audits, denials management, and audit responses, while partnering with Clinical Documentation Integrity and Revenue Cycle to strengthen revenue integrity.

Role requires advanced reimbursement knowledge, regulatory interpretation, and the ability to present complex analyses to leadership. Hybrid work within Iowa is available.

Qualifications

• Bachelor’s degree or equivalent in business, finance, or clinical field.
• Experience with Epic Patient Accounting System.
• 5 years in professional and facility revenue cycle operations.
• 2 years of supervisory experience.
• 2 years of experience with clinical/administrative denials and appeals.
• Working knowledge of physician and hospital reimbursement methods.
• Advanced experience with Microsoft Excel.
• Nursing or clinical background preferred.

Responsibilities

• Lead audit and appeal operations across centralized program including external and internal audits.
• Establish program metrics, dashboards, and reporting cadence with Revenue Integrity leadership.
• Develop and execute denial/appeal strategies to optimize reimbursement.
• Monitor and report KPIs: overturn rates, audit accuracy, financial impact, response time.
• Translate data into actionable insights for leadership and stakeholders.
• Collaborate with Revenue Cycle, Compliance, Coding, and clinical teams to resolve issues.
• Ensure compliance with federal regulations and payer requirements; refine workflows.
• Lead continuous improvement in denial prevention and revenue integrity.
• Manage and develop audit/appeal staff; performance management and training.
• Serve as SME on audit/appeal processes and regulatory changes.
• Be primary contact for audit tracking software.

Skills

Excellent written & verbal comms

Project management

Microsoft Office proficiency

CPT-4 & ICD-10 knowledge

Analytical storytelling to leadership

Regulatory interpretation

Education

Bachelor’s degree in business, finance, or clinical field

Master’s degree preferred

Tools

Epic Patient Accounting System

Job description

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 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.
• 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

Up to 5 professional references will be requested at a later step in the recruitment process.

For questions, contact Sharon Walther at [e-mail] .

Additional Information

• Appointment Type: Professional and Scientific
• Schedule: Full-time
• Work Modality Options: Hybrid within Iowa

Contact Information

• Contact Name: Sharon Walther
• Contact Email: [e-mail]

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, [phone] or [e-mail] . For jobs in UI Health care, please contact UI Health care Leave & Disability Administration at 319-356-7543 .