Manager Denials Audits and Appeals - Revenue Integrity Process

Penn State Health; Hershey (PA); On-site; USD 90,000 - 120,000; Full time

Job summary

Penn State Health is seeking a Manager Denials Audits and Appeals within Revenue Integrity to oversee and optimize the inpatient appeals process and respond to third-party audits from Medicare, Medicaid, and commercial insurers.

This role leads the External Payer Audits and Appeals team, partners with cross-functional teams to reduce denials, improve reimbursement, and increase efficiency in the appeals workflow while managing staff performance.

Qualifications

• Bachelor's Degree or equivalent experience (4 years).
• Nine (9) years job related experience required.

Responsibilities

• Oversee and optimize the inpatient appeals process and manage responses to third-party audits from Medicare, Medicaid, and commercial insurers.
• Lead the strategy around inpatient denials and third-party audit responses to improve reimbursement and reduce follow-up work by PFS staff.
• Manage the External Payer Audits and Appeals team and drive performance management of staff.
• Collaborate with cross-functional teams to identify corrective actions to reduce audit denials and enhance efficiency of the appeals process.

Education

Bachelor's Degree or equivalent experience

Job description

Manager Denials Audits and Appeals - Revenue Integrity Process

Invest in Your Future and Theirs: Beginning January 1, 2027, eligible full-time Penn State Health employees receive a 50% Penn State tuition discount for themselves and eligible dependents, including a spouse and children. The discount applies at Penn State University Park, Commonwealth Campuses, World Campus, and Penn College of Technology.

Responsible for overseeing and optimizing the the appeals process and managing responses to third-party audits, including payer audits from Medicare, Medicaid, and commercial insurers. This role focuses on managing the overall inpatient appeal strategy of Penn State Health as well as managing the strategy around third-party audit response. In addition to responsibility to response to payers as it relates to appeals and audits, this role is also responsible for working with teams across the health system to identify and implement corrective actions to reduce audit denials and inpatient denials, with a goal of improving reimbursement, reduce follow-up work needed by PFS staff, and enhance the overall efficiency and effectiveness of the appeals process. This position manages the External Payer Audits and Appeals team and engages in the performance management of staff.

MINIMUM QUALIFICATION(S):

• Bachelor's Degree or equivalent experience (4 years)
• Nine (9) years job related experience required.

WHY PENN STATE HEALTH?

Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.

Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:

• Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton).
• Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave.
• Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection.
• Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program.
• Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling.

WHY PENN STATE HEALTH CORPORATION?

There are many ways to make an impact with one of the leading research, teaching, and clinical healthcare systems in the country. Through a combination of operational, corporate, clinical, and nonclinical roles, we are advancing excellence and innovation in health care together as one team. As Penn State Health continues to evolve for the future, we are committed to hiring dedicated employees who are passionate about delivering the best possible support across our entire integrated health system.

Within Penn State Health’s Shared Services Entity, we encourage our employees at every turn to continue their education and advancement. Numerous opportunities are available for professional development and career growth.

YOU TAKE CARE OF THEM. WE’LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence – that’s Penn State Health. But what makes our healthcare award-winning? That’s all you.

This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.

Penn State Health is an Equal Opportunity Employerand does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health’s policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.

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