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

Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida.

Baptist Health Care, Inc. is an Equal Opportunity Employer. BHC maintains and enforces a policy that prohibits discrimination against any workforce members or applicants for employment because of sex, race, age, color, disability, marital status, national origin, religion, genetic information, or other category protected by federal, state or local law. Certain positions may require a Level 2 Background check through AHCA. Additional information about this requirement can be found here: Florida Care Provider Background Screening Clearinghouse