What are the responsibilities and job description for the Denials Prevention Specialist - Registration Quality position at Western Missouri Medical Center?
Position Summary
The Denials Prevention Specialist – Registration Quality 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.
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1. Registration Quality Review (Primary Function)
- Audit patient accounts for accuracy in:
o Insurance selection and plan accuracy
o Member ID and group number
o Demographics (name, DOB, address)
o Guarantor information
o Coordination of benefits (COB)
- Work MEDITECH work queues:
o REG-ERR-*
o REG-ELIG-*
o Registration-related denial queues (DEN-ELIG-*, DEN-REG-*)
- Correct errors prior to claim submission when possible
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2. Denial Root Cause Analysis (Front-End Focus)
- Review denied claims to identify registration-driven root causes, including:
o Eligibility failures
o Incorrect payer selection
o Missing or incorrect subscriber data
- Categorize and track denial trends tied to registration issues
- Quantify impact (volume, dollars, repeat errors)
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3. Front-End Process Improvement
- Identify workflow gaps in:
o Scheduling
o Registration
o Eligibility verification
- Recommend and help implement process improvements to reduce errors at intake
- Partner with leadership to standardize front-end practices
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4. Education & Training
- Provide ongoing education to Patient Access staff on:
o Common registration errors
o Payer-specific requirements
o Best practices for insurance capture
- Develop quick-reference guides and training materials
- Conduct targeted retraining for individuals or departments with high error rates
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5. Collaboration Across Revenue Cycle
- Work closely with:
o Denial Specialists (to understand downstream impact)
o Billing QA (to align front-end corrections with claim edits)
o Coding (when registration impacts billing accuracy)
- Participate in cross-functional denial prevention meetings
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6. Work Queue & SLA Management
- Maintain assigned MEDITECH work queues:
o Prioritize high-risk and high-dollar accounts
o Ensure timely correction of errors before billing
- Meet established turnaround times (typically =24–48 hours pre-bill)
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7. Reporting & Performance Monitoring
- Track and report:
o Registration-related denial rates
o Error trends by registrar/location
o Improvement over time
- Provide actionable insights to leadership
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Work Queue Ownership
- REG-ERR-*
- REG-ELIG-*
- DEN-ELIG-* (for root cause analysis and feedback loop)
- Registration-related pre-bill edit queues