With more than 25 years of experience spanning medical billing, coding, auditing, clinical validation, and denial management, Robin Sewell, CDIP, CCS, CIC, CPC, CCDS has built a career by understanding healthcare revenue integrity from every angle.
Today, as Lead Clinical Coding Analyst at Brundage Group, Robin helps healthcare organizations strengthen DRG accuracy and reduce denial risk before claims are submitted. But her understanding of denial management and DRG integrity was built through a path that was anything but linear.
In fact, much of her expertise was built by working on the opposite side of the table.
From Physician Billing to Revenue Integrity
Robin’s healthcare career began in the late 1990s, providing medical billing services for physician practices while raising her children at home.
“I wanted to have my own business so I could be home with my kids,” she recalled. “This was during the dial-up internet era, so everything took a little longer, but it gave me exposure to a wide variety of specialties and how reimbursement worked.”
As payer requirements became increasingly complex, Robin found herself drawn to the broader challenges of healthcare reimbursement and documentation. After earning inpatient coding credentials, she transitioned into the hospital space and eventually discovered a passion for DRG auditing.
“I thought I was going to love coding,” she said. “What I realized was that I enjoyed auditing much more. I liked identifying problems, finding opportunities, and understanding why things happened.”
That curiosity ultimately led her into the payer world, where she spent years conducting DRG audits, developing recovery concepts, and reviewing provider appeals for some of the nation’s largest health plans.
Learning the Payer Playbook
Robin’s experience reviewing claims and appeals on behalf of payers gave her an uncommon advantage: she learned exactly what auditors look for when evaluating documentation, coding accuracy, and clinical support.
“I was reading the appeal letters hospitals submitted and deciding whether I agreed with them or not,” she explained. “That experience taught me what the auditor on the other side wants to see.”
Over time, Robin became known for her deep understanding of payer tactics and denial trends. Her unique perspective earned her the nickname “Queen of Denial,” which eventually inspired her to develop a denial analytics application.
The tool helped organizations identify denial patterns, track root causes, and uncover documentation gaps that contributed to reimbursement challenges.
“It allowed us to drill down into why denials were happening,” Robin said. “Instead of just looking at the denial itself, we could identify documentation issues, education opportunities, and patterns that needed attention.”
While technology has evolved significantly since then, the experience reinforced something Robin continues to believe today: understanding denial risk requires more than simply reacting to denials after they occur.
Moving from the Payer to Provider Side
After years of working for payers, Robin transitioned to the provider’s side.
“I guess I got a little burned out being on the payer’s side,” she stated.
She joined Brundage Group initially supporting denial management efforts. Around the same time, she began collaborating with Dr. Rao on what would eventually become Brundage Group’s DRG Integrity service line.
“Dr. Rao told me we were going to build a DRG program,” Robin said. “I’ve been involved from the beginning, helping develop the rules, workflows, and processes that support what we’re doing today.”
That work continues to evolve as Robin develops sophisticated review rules designed to identify claims with the highest likelihood of denial risk, documentation concerns, or reimbursement opportunities.
Why Denial Prevention Matters
While many organizations still view DRG reviews primarily as a revenue optimization strategy, Robin believes the industry’s biggest opportunity today is denial prevention.
“The misconception is that DRG reviews are only about finding additional reimbursement. The reality is that a significant part of what we do is identifying denial risk before a claim ever goes out the door.”
Robin Sewell, CDIP, CCS, CIC, CPC, CCDS
With clinical validation denials continuing to increase, Robin sees firsthand how payer scrutiny affects hospitals and health systems.
“There’s really no end in sight to the denials,” she said. “The best opportunity is to catch issues before billing and give organizations a chance to address them proactively.”
That proactive approach is one of the reasons she strongly believes in pre-bill DRG review.
“Getting it right the first time is really what we’re trying to do,” Robin explained. “If organizations can identify documentation concerns, coding risks, or potential denial issues before billing, they’re in a much better position than trying to fix everything after the fact.”
A Different Approach to DRG Integrity
When asked what sets Brundage Group apart from other vendors, Robin points to the depth of review and the collaborative expertise behind every recommendation.
“We go much deeper into the details. We’re not just looking at one piece of the claim. We’re evaluating it from coding, CDI, utilization management, and clinical perspectives.”
That multidisciplinary approach allows Brundage Group to identify risks that might otherwise be missed while helping organizations avoid recommendations that could create future denial exposure.
“We’re not interested in recommending something simply because it increases reimbursement,” Robin explained. “If we know it’s likely to create a clinical validation issue later, we’re going to tell the client that.”
For Robin, success isn’t measured by how many claims are touched. It’s measured by helping organizations submit accurate claims, reduce rework, and strengthen revenue integrity.
Looking Ahead
Even after more than two decades in healthcare, Robin remains energized by solving complex reimbursement challenges and finding new ways to improve the review process.
One area that particularly excites her is the opportunity to combine utilization management insights with DRG expertise earlier in the patient journey—helping identify opportunities before coding is even finalized.
“We’re always looking for ways to be more proactive,” she said. “The goal is to help organizations identify opportunities and risks as early as possible.”
That mindset—always asking what comes next and how processes can be improved—has been a constant throughout Robin’s career.
From physician billing and coding to payer audits, denial management, and DRG integrity, she’s spent more than 25 years understanding every side of the reimbursement process.
Today, healthcare organizations benefit from that experience every time she helps them prevent a denial before it happens.
And if there’s one thing Robin has learned along the way, it’s that sometimes the best way to win an appeal is to never need one in the first place
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