Denial Recovery and Prevention Specialist

Determine why a medical claim was denied and make corrections if possible.

What does a Denial Recovery and Prevention Specialist do?

One of the lesser-known jobs in health care, the position of “Denial Recovery and Prevention Specialist” is found in hospitals and medical offices. Working within the accounts receivable department, a Denial Recovery and Prevention Specialist helps the hospital get paid.

As a Denial Recovery and Prevention Specialist, you work with Accountants, Accounts Payable Clerks, and Hospital Administrators. Combining your mathematics, English, communication, and computer skills, you appeal claims made against the government or insurance companies.

For example, when an insured patient receives treatment and services from the hospital’s Physicians and medical staff, a claim is sent to the insurance provider for payment. When things go smoothly, the claim is paid and everyone is happy. When a claim is denied, that’s where you come in.

Contacting the appropriate agency, you determine why the claim was denied, and make corrections if possible. In some cases, it is merely a medical coding error that’s easily fixed, but in others, it could be a long battle to reach agreement.

Attention to detail is essential in this position, as you keep track of patient information and claim status. Accuracy is vital as well: One wrong letter could mean the difference between payment and denial.

Your work is likely to be mentally tasking, but rarely physical in nature. General office skills, patience, and self-confidence are necessary, as you work directly with many people in powerful positions.