Enterprise Denial Coordinator

Marshall Health Network, Inc.

Position Summary

Marshall Health Network is seeking an Enterprise Denial Coordinator to support denial prevention efforts across its hospitals and provider organizations. This position analyzes enterprise denial data, identifies trends and root causes, and coordinates collaborative initiatives to reduce preventable denials and improve reimbursement performance.

The Enterprise Denial Coordinator translates denial data into actionable insights that help operational leaders identify improvement opportunities, develop corrective action plans, and measure results. This role also facilitates the Enterprise Denial Prevention Workgroup and provides consolidated reporting to executive leadership to support informed decision-making and strengthen revenue cycle performance across the organization.

Essential Functions and Responsibilities

• Analyze enterprise denial data by payer, hospital, provider organization, service line, denial category, CARC/RARC code, volume, and financial impact.

• Coordinate the standardized classification, collection, validation, and aggregation of denial data across hospitals and provider organizations.

• Identify denial trends, emerging risks, and prevention opportunities using dashboards, reporting tools, and AI-assisted analytics.

• Lead and facilitate the Enterprise Denial Prevention Workgroup, promoting collaboration and accountability across departments.

• Coordinate multidisciplinary root cause analyses and work with operational leaders to identify appropriate owners for improvement opportunities.

• Facilitate the development of corrective action plans led by operational departments and monitor progress toward established goals.

• Evaluate the effectiveness of improvement initiatives and report measurable outcomes, including financial impact and changes in denial performance.

• Develop and provide consolidated executive dashboards and reports to the Vice President of Revenue Cycle, summarizing denial trends, financial impact, payer performance, root causes, and recommended prevention priorities.

• Monitor Medicare, Medicaid, Medicare Advantage, and commercial payer policy changes that may affect claim denials and reimbursement.

• Develop and coordinate denial prevention education based on enterprise trends and identified opportunities.

• Recommend standardization opportunities and best practices to improve first-pass payment rates and reduce preventable denials.

• Build collaborative relationships with clinical, financial, revenue cycle, and operational teams to support enterprise denial prevention strategies.

• Promote consistent data reporting, performance measurement, and follow-up on denial prevention initiatives across the organization.

Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field, or equivalent experience.

• Five years of progressive healthcare revenue cycle experience.

• Experience with hospital and professional billing.

• Experience in denial analytics, reimbursement, or revenue cycle performance improvement.

• Knowledge of hospital and professional revenue cycle operations.

• Knowledge of Medicare, Medicaid, Medicare Advantage, and commercial payer reimbursement methodologies.

• Familiarity with denial management principles, CARC/RARC codes, medical necessity requirements, and payer guidelines.

• Strong analytical, organizational, communication, facilitation, and presentation skills.

• Ability to interpret complex data and translate findings into actionable recommendations.

• Ability to build collaborative relationships across clinical, financial, and operational departments.

Preferred Qualifications

• Relevant certification, such as CRCR, CHRI, CPC, CCS, RHIA, RHIT, or an equivalent credential.

• Experience with healthcare business intelligence, analytics, dashboards, and reporting tools.

• Experience facilitating multidisciplinary workgroups or performance improvement initiatives.

• Experience developing executive-level reports and presenting data-driven recommendations to leadership.

Key Performance Expectations

Success in this role is measured by the ability to transform complete and consistently classified denial data into actionable business intelligence, facilitate collaboration among operational leaders, and identify opportunities that produce measurable improvements in reimbursement performance.

Key performance indicators include:

• Timely identification of high-impact denial trends and emerging risks.

• Accuracy and timeliness of enterprise denial data aggregation and executive reporting.

• Identification and financial evaluation of denial prevention opportunities.

• Reduction in preventable denial rates and denial dollars within targeted categories.

• Improvement in first-pass payment rates.

• Completion and follow-up of denial prevention action plans.

• Adoption of standardized denial prevention practices across hospitals and provider organizations.

• Effectiveness of enterprise denial prevention workgroup initiatives.