Manager, denial prevention, trends and audits

SUMMARY:

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.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Denial Trend Identification & Root-Cause Analytics
• Cross-Functional Partnership & Targeted Solution Development
• Epic Optimization & Systemic Controls
• Quantifiable Impact & Continuous Improvement
• Daily Operations & Work Queue Management
• Denial Resolution Execution (Technical & Medical Necessity)
• Audit Intake & Response Coordination
• Quality Assurance & Documentation Standards
• Performance Management & Staff Oversight
• Reporting & Operational Metrics

Performs other duties as assigned.

EDUCATION:

Bachelor’s degree required (Healthcare Administration, Business, Finance, or related field); equivalent experience in healthcare revenue cycle will be considered in lieu of degree. Master’s degree preferred.

EXPERIENCE:

5+ years of hands-on Revenue Cycle experience. 3+ years of experience managing denial, AR, or audit operations. 3+ years of direct, hands-on Epic experience required (Resolute HB strongly preferred), including practical use of work queues, claim edits, denial/remit posting, and reporting tools; prior experience partnering with Epic analysts or an Epic optimization team on build or optimization projects is required.

SUPERVISORY RESPONSIBILITY:

Direct Reports: Denial Specialists, Denial Analysts, Audit Coordinators

Note: Clinical appeal nursing functions have transitioned to Revenue Integrity. This role does not directly supervise clinical appeal nurses but is accountable for active partnership with Revenue Integrity to align clinical and technical denial strategy, share trend data, and coordinate solution timelines. This role also works in close, ongoing partnership with Brown University Health’s Epic Optimization Team on all Epic-related denial prevention system changes.

Pay Range:

$100,027.20-$165,048.00

Location:

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type:

M-F 8 - 5

Work Shift:

Day

Daily Hours:

8 hours

Driving Required:

No