Applying a collaborative approach to denials management
Editor’s note: Robin Gantea, MSN, RN, CRCR, and Lynn Marie Shay, MBA, CHFP, CPHQ, CRCR, will present “Driving Success Through Collaboration: Denials Management Across the Revenue Cycle” on day one of the 2026 Revenue Integrity Symposium, which will take place September 24–25 in Savannah, Georgia. Gantea is the executive director, utilization management, clinical documentation integrity, QA, education, and policy at Baptist Health in Jacksonville, Florida. Shay is the director, denials and appeals at Baptist Health in Jacksonville, Florida. Download the 2026 RIS brochure to learn more about the event! Use NAHRI’s justification letter template as a guide to gain your organization’s support for attending. Consider applying for the NAHRI Scholarship, which awards free registration to RIS (the application deadline is June 19).
Q: In what ways does your session challenge attendees to think outside the box?
Shay: Our session reinforces the importance of collaboration not only within individual verticals, but across all pillars of the organization. We emphasize that meaningful and sustainable success in denials and prevention is best achieved through strong cross‑functional partnerships and open communication across the full continuum of patient care.
Gantea: Our session also challenges attendees to move beyond reactive problem-solving and adopt a proactive, systems-thinking mindset. We encourage leaders to question traditional workflows, leverage data in more predictive ways, and explore innovative strategies such as real-time intervention points, physician engagement models, and technology-enabled insights. By reframing denials not as isolated events but as signals of upstream process opportunities, participants are prompted to rethink how their teams can drive prevention, improve documentation accuracy, and influence outcomes earlier in the care continuum.
Q: What’s the biggest challenge in revenue integrity and/or revenue cycle right now? How does your session help tackle this?
Shay: From my perspective, the primary challenge is twofold. First, claim denials and post‑payment audit activity continue to be a significant operational burden for the revenue cycle. Evolving payer processes, including increased automation, fewer concurrent review opportunities, and a higher volume of post‑claim audits, have extended resolution timelines and increased rework. Second, growing variability in payer policies, particularly where Medicare Advantage criteria differ from CMS guidance, creates additional complexity and barriers to reimbursement. Payers are increasing the utilization of policy language related to medical necessity, bundling, and experimental designations for devices, procedures, and supplies. Together, these factors contribute to lost or delayed reimbursement and require increased investment in labor, analytics, and technology to effectively manage and resolve denials.
Gantea: Our session also highlights the growing challenge of fragmented accountability across the revenue cycle, where ownership of denials and prevention efforts can become siloed between clinical, operational, and financial teams. This lack of alignment often limits an organization’s ability to address root causes and sustain meaningful improvement. We address this by introducing structured governance models, clear role delineation, and shared performance metrics that promote collective ownership. By aligning stakeholders around common goals and creating transparency across workflows, attendees gain practical strategies to break down silos, strengthen accountability, and drive more consistent, organization-wide performance improvement.
Q: What’s one of the key pieces of information you would like people to take away from your session?
Shay: Collaboration and communication are key to sustainable success.
Gantea: One of the key takeaways from our session is that sustainable revenue cycle improvement depends on shifting from a reactive, denial management mindset to a proactive, prevention-focused strategy.
Q: What are you most excited about for this year’s conference?
Shay: I am excited to network with peers who are subject matter experts in revenue integrity. Prevention has just recently begun a journey on a new partnership with our revenue integrity team, and I am still in the learning stages of revenue integrity operations.
Gantea: I agree with Lynn
Q: What's a great piece of advice you've received regarding revenue integrity and/or revenue cycle? Or what advice do you like to give people about revenue integrity and/or revenue cycle?
Shay: Fail fast, learn, and move forward. Rather than waiting for perfect solutions, test targeted claims, adapt appeal strategies, and engage partners collaboratively. Discomfort and disagreement are often part of progress, but strong relationships and open dialogue help teams move through challenges and achieve better outcomes together.
Gantea: Another important piece of advice is to stay relentlessly focused on the “why” behind the work. Revenue integrity is not solely about financial outcomes: It directly supports patient care, compliance, and the long-term sustainability of the organization. When teams understand how accurate documentation, appropriate utilization, and effective denial prevention contribute to the broader mission, they are more engaged and aligned. Grounding decisions in purpose helps leaders prioritize effectively, navigate complexity, and maintain momentum even when challenges arise.