Denials Prevention Specialist

Position Summary

The Denials Prevention Specialist is responsible for identifying, correcting, and preventing registration-related errors that lead to claim denials. This role focuses on improving front-end data integrity within MEDITECH, working across Patient Access, Billing QA, and Denials teams to reduce eligibility, authorization, and demographic-related denials. This position serves as the bridge between front-end operations and downstream revenue cycle performance, ensuring that patient accounts are accurate before claims are created. This role ensures that patient information is accurate from the start, reducing rework, accelerating cash flow, and improving overall revenue cycle performance by eliminating errors before they become denials.

Registration Quality Review (Primary Function)

Audit patient accounts for accuracy in:

• Insurance selection and plan accuracy
• Member ID and group number
• Demographics (name, DOB, address)
• Guarantor information
• Coordination of benefits (COB)

Work MEDITECH work queues:

• REG-ERR-*
• REG-ELIG-*
• Registration-related denial queues (DEN-ELIG-*, DEN-REG-*)
• Correct errors prior to claim submission when possible

Denial Root Cause Analysis (Front-End Focus)

Review denied claims to identify registration-driven root causes, including:

• Eligibility failures
• Incorrect payer selection
• Missing or incorrect subscriber data
• Categorize and track denial trends tied to registration issues
• Quantify impact (volume, dollars, repeat errors)

Front-End Process Improvement

Identify workflow gaps in:

• Scheduling
• Registration
• Eligibility verification

Recommend and help implement process improvements to reduce errors at intake. Partner with leadership to standardize front-end practices.

Education & Training

Provide ongoing education to Patient Access staff on:

• Common registration errors
• Payer-specific requirements
• Best practices for insurance capture

Develop quick-reference guides and training materials. Conduct targeted retraining for individuals or departments with high error rates.

Collaboration Across Revenue Cycle

Work closely with:

• Denial Specialists (to understand downstream impact)
• Billing QA (to align front-end corrections with claim edits)
• Coding (when registration impacts billing accuracy)

Participate in cross-functional denial prevention meetings.

Maintain Assigned MEDITECH Work Queues

- Prioritize high-risk and high-dollar accounts - Ensure timely correction of errors before billing - Meet established turnaround times (typically =24–48 hours pre-bill)

Reporting & Performance Monitoring

Track and report:

• Registration-related denial rates
• Error trends by registrar/location
• Improvement over time
• Provide actionable insights to leadership

Work Queue Ownership

- REG-ERR-* - REG-ELIG-* - DEN-ELIG-* (for root cause analysis and feedback loop) - Registration-related pre-bill edit queues

Educational & Experience Requirements

- High School Diploma or equivalent required, higher education preferred. - 3+ years of Patient Access, eligibility, or revenue cycle experience required. - Experience working in an EHR system (MEDITECH preferred). - Insurance plans (Medicare, Medicaid, Commercial). - Eligibility verification and registration workflows. - Common causes of front-end denials. - Experience in denial management or revenue integrity. - Knowledge of payer rules and authorization requirements. - Certification (required) – may obtain within one year of employment: CRCR (Certified Revenue Cycle Representative), or CPB (Certified Professional Biller)

Key Competencies

- Strong analytical and problem-solving skills - Attention to detail and data accuracy - Ability to identify patterns and root causes - Effective communication and training skills - Ability to influence process improvement across teams

Performance Metrics

- Reduction in registration-related denial rate - % of accounts corrected pre-bill - Accuracy rate of audited registrations - Work queue turnaround time - Reduction in repeat errors by staff or location