Denials Prevention Specialist

The Denials Prevention Specialist is responsible for proactively identifying, analyzing, and mitigating denial trends across the revenue cycle to improve reimbursement and reduce avoidable write-offs. The role partners closely with Patient Access, Coding, Clinical Departments, and Revenue Cycle teams to ensure accurate, compliant, and complete claim submission processes. The Specialist focuses on root cause analysis, education, and process improvement to prevent denials before they occur.

• Monitors, tracks, and trends denial data to identify systemic issues and opportunities for prevention.
• Performs root cause analysis on denials (e.g., authorization, eligibility, coding, medical necessity, timely filing).
• Develops actionable insights and recommendations to reduce denial rates and rework.
• Ensures compliance with payer requirements, CMS guidelines, and internal policies.
• Creates and maintains denial dashboards, reports and presentations (KPIs such as denial rate, overturn rate, preventable denials).
• Presents findings and recommendations to leadership and committees for implementation.
• Tracks effectiveness of interventions and processes changes.
• Serves as a liaison between departments to ensure alignment in denial prevention efforts.
• Works with managed care/payer relations on recurring denial issues for contract support.
• Participates in payer JOC meetings to address and resolve systemic denial drivers.

Minimum Education
 

• Bachelor's Degree Business, Health Care Administration, Related field Required or
• Four years of related experience may be considered in lieu of degree Required

Minimum Work Experience
 

• 3 years Revenue cycle experience in billing, coding or denial management. Required
• 3 years Denials research and resolution experience. Preferred
• 3 years Experience with EHR and billing systems (e.g., Epic, Cerner, Meditech). Preferred