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   Current UPHS employees must apply HERE

Supervisor, Managed Care Audits and Appeals Recovery

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Job ID: 202325
Category: Accounting/Finance
Work Type: FT
Location: Philadelphia, PA, United States
Work Schedule: M-F; 8-hour day shift | Remote

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Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Supervisor, Managed Care Audits and Appeals Recovery

This position can be worked remotely from anywhere within the tri-state area.

Job Summary:

  • Working under limited supervision, the Supervisor, Managed Care Audit and Appeals Recovery reviews Managed Care Payer retrospective audits to determine validity within specific contract terms. Addresses audit disputes directly with the payer and/or third-party payer auditor, while keeping Senior Management and multiple internal departments apprised of findings. Assists in the collection of and conducts high level administrative claims appeals on problematic accounts.


  • Direct and oversee incoming Managed Care payer audit process utilizing COBIUS system, or other assigned system.
  • Analyze and validate audit findings for accuracy within specific payer contract terms.
  • Dispute erroneous findings directly with third party auditors/payers, while keeping UPHS management and responsible staff informed.
  • Ensure audits are addressed in a timely manner to avoid payment retractions.
  • Correspond with key personnel in multiple areas within UPHS, including but not limited to CRM, HIM, Patient Access, Patient Accounting and Managed Care concerning trends in found issues.
  • Participate in payer meetings to discuss problematic accounts.
  • Refer accounts to outside collection attorney on cases which have reached an impasse.
  • Orchestrate concise and compelling appeals in the administrative denial of large dollar (> $5k) cases.
  • Assist in, and share in the responsibility of UPHS Management in attaining yearly cash collection goals.
  • Document monthly audit activity, report potential loss and recoverable revenue through dispute resolution.
  • Maintain close contact close contact with the staff of HIM, CRM and Patient Accounting to ensure all issues relating to Managed Care audits are being addressed.
  • Review incoming third party reimbursement audits with a heavy focus on DRG Reassignments and IP Level of Care
  • Thoroughly document each case in EPIC, Date of Audit, Audit Company conducting audit and detailed findings related to clinical validation of Coding or Level of Care.
  • Facilitate timely issuance of audits to the Health Information and Clinical Resource Management staff of the five PennMedicine Hospital Facilities to ensure timely appeals.
  • Ensure all work entering the HB Audit Workqueue in Onbase is completed within the same day received and/or no later than the next business day.
  • Forward Coordination of Benefits Audits to A/R Team Representative to verify eligibility/initiate billing of new insurance.
  • Dispute any invalid/erroneous audit back to Third Party Auditors and Payer Network Representatives.
  • Inform Penn A/R Management, Contracting and Contracted Payers of ongoing negligence / erroneous audits that are in violation of our contracts.
  • Perform as System Administrator for the DPW Epromise system.
  • Fulfill requests for E-Promise system sign-ons for new Penn and A/R vendor employees
  • Assist in the completion of PA MA Revalidations of all Penn hospital service locations, specifically providing/inputting required confidential Hospital Board Member information in the online revalidation applications.
  • Act as an intermediary between Penn Medicine Clinical Staff, A/R Staff and Contracted A/R vendors in assisting in the resolution of problematic cases.
  • Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
  • Other duties as assigned to support the unit, department, entity, and health system organization.

    Education/ Experience:

    • H.S. Diploma/GED (Required).
    • 5+ years of Revenue Cycle experience for a multi hospital facility (Required).

    Skills & Abilities:

    • Highly effective verbal and written communication skills.
    • Ability to deal professionally with all levels of internal and external staff and management.
    • Proven ability to understand and assimilate multiple contract nuances across all payers.
    We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

    Live Your Life's Work

    We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

       Current UPHS employees must apply HERE
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