Revenue Integrity Manager: Denials, Audits & Appeals

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

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.