Manager, Denial Prevention, Trends and Audits

The Manager, Denial Prevention, Trends and Audits is a critical Revenue Cycle leadership role responsible for converting denial and audit activity from a reactive, transactional queue into a proactive, analytics-driven program that identifies Hospital Billing (HB) denial trends, diagnoses root cause, and drives targeted, timeline-bound solutions in partnership with every area that touches the HB claim life cycle
- Patient Access/Financial Clearance, HB Coding & CDI, Revenue Integrity, Contracting, Case Management/UR, the Epic Optimization Team, and clinical departments.

This role owns day-to-day operational performance of the non-clinical HB denial and audit team (technical, administrative, and eligibility/authorization-related denials and audit coordination) and serves as the Revenue Cycle's primary driver - working in close, ongoing partnership with Brown University Health's Epic Optimization Team - for maximizing Epic HB system effectiveness: building system-based controls, automation, and standard work that prevent denials before submission, reduce manual rework, and reduce the training burden required to sustain the function.

Clinical denial and appeal work (e.g., medical necessity, level-of-care) is managed within Revenue Integrity's clinical appeal nursing team; this role is directly accountable for partnering with that team so clinical and technical denial strategies operate as one aligned program rather than two disconnected efforts.

Strong, hands-on Epic HB expertise is a core and non-negotiable requirement of this role. The manager must be able to read and interpret Epic HB work queue logic, claim edits, and BPA build well enough to translate front-line denial patterns into precise, actionable system change requests for the Epic Optimization Team, and to validate that delivered fixes actually close the gap.

• Own HB denial trend intelligence: aggregate and analyze Hospital Billing denials by payer, reason/CARC-RARC code, service line, site of care, and root cause to separate one-off errors from recurring, systemic workflow failures.
• Apply structured root-cause analysis (RCA): move beyond claim-level firefighting to population-level diagnosis - identifying the upstream scheduling, registration, authorization, documentation, coding, or system failure generating a denial cluster, not just the individual claim fix.
• Build and maintain a denial trend dashboard: using Epic reporting tools (Cogito, Slicer Dicer, Workbench/Radar) to visualize denial rate, volume, dollar impact, and recovery rate by category, payer, and accountable owner on a weekly/monthly/quarterly cadence.
• Quantify impact to prioritize action: size each trend by dollars at risk, FTE hours consumed, and recurrence rate so cross-functional intervention is focused on the highest-value opportunities first.

• Partner with every upstream and downstream stakeholder
  - Patient Access/Financial Clearance, HB Coding & CDI, Revenue Integrity, Contracting/Payer Strategy, Case Management/UR, the Epic Optimization Team, and clinical departments - to convert denial trend findings into targeted, root-cause-specific action plans.
• Lead corrective action planning: for every significant trend, define the accountable owner, the proposed solution, and a committed implementation timeline; track progress to closure and validate the fix through post-implementation denial-rate monitoring.
• Facilitate a recurring cross-functional denial governance forum: bring stakeholder owners together - including the Epic Optimization Team - to review open trends, agree on solutions, and hold owners to committed timelines, creating a single, shared accountability structure across Revenue Cycle, Epic, and clinical/operational partners.
• Escalate systemic issues to leadership: with supporting data, quantified financial/operational impact, and a recommended resolution path when a fix requires executive sponsorship, payer engagement, or capital/system investment.

• Serve as the primary Denial Prevention liaison to the Epic Optimization Team, translating recurring HB denial and audit patterns into concrete Epic build requests - work queue logic, claim edits, Best Practice Advisories (BPAs), medical necessity checks, real-time eligibility (RTE) and authorization edits, and charge/order routing rules.
• Identify…