Carrier Revenue Analyst

Progyny, Inc.•New York, NY

2d•$65,000 - $80,000•Hybrid

About The Position

Thank you for considering Progyny! We are seeking a detail-oriented and analytical Carrier Revenue Analyst to support backend Revenue Cycle Management (RCM) operations, with a strong focus on claims investigation, denial resolution, and revenue recovery. This role is responsible for deep-dive analysis of claims across commercial payors, identifying root causes of payment discrepancies, and driving resolution through internal remediation and external carrier engagement. The ideal candidate brings at least 1+ year of healthcare claims processing or RCM experience, with a strong foundation in claim adjudication workflows, denial management, and reimbursement methodologies.

Requirements

Bachelor’s degree or equivalent experience
1+ year of healthcare RCM or claims processing experience
Working knowledge of: Claims lifecycle (837, 835, 277/276, EOB interpretation)
Experience working with commercial carriers (e.g., Aetna, Anthem, UHC, etc.)
CPT/HCPCS coding
Commercial payor workflows and adjudication logic
Experience with denial investigation, appeals, and claims corrections
Advanced proficiency in Microsoft Excel (pivot tables, formulas, data analysis)
Experience in backend RCM functions such as: Denials management, Payment reconciliation, or AR follow-up
Extensive analytical and critical thinking skills with a focus on problem-solving and root cause identification
High attention to detail with the ability to manage large datasets and complex claim scenarios
Effective communication skills, with the ability to translate findings into clear, actionable insights
Ability to thrive in a fast-paced, high-volume environment while maintaining accuracy
Self-starter mindset with ownership over assigned workstreams and outcomes

Nice To Haves

Familiarity with SQL or data querying tools
Familiarity with Clearinghouses, Provider Portals, SalesForce, Pharmacy (PBM), Medical claims
Exposure to reporting tools such as Power BI

Responsibilities

Perform detailed review of claims lifecycle (submission through adjudication) to identify denials, underpayments, recoupments, and processing errors
Conduct root cause analysis across claim issues, including eligibility, COB, coding, billing, and payer policy misalignment
Validate claims against contracted reimbursement terms, medical policies, and billing guidelines
Investigate and categorize denials
Partner with internal teams and external payors to drive reprocessing, appeals, and corrections
Identify trends and systemic issues impacting reimbursement and recommend scalable remediation strategies
Reconcile payments using 835/EOB data to ensure accurate posting and identify discrepancies
Monitor and track unapplied cash, posting errors, and claim status gaps
Act as a liaison between internal teams and external carriers
Escalate and track issues with payors, ensuring timely follow-up and resolution
Support client and leadership requests with clear, data-driven summaries of claim performance
Ensure adherence to HIPAA, billing compliance, and internal policies
Contribute to process standardization and automation efforts to improve efficiency and reduce manual errors
Participate in QA initiatives and continuous improvement of claims workflows
Support rebill workflows by validating corrected claims and ensuring proper submission logic
Analyze claims and financial data using Excel (required) and SQL (preferred) to uncover trends and performance gaps
Develop and maintain reports and dashboards to track: Denial rates, First-pass resolution, Net collection rate, and Aging AR and recovery progress
Provide actionable insights to leadership on revenue leakage and operational inefficiencies

Benefits

Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation Group
Menopause and midlife care
Health, dental, vision and life insurance options for employees and family
Free in-person, virtual and text-based mental health and wellness support
Paid time off, including vacation, sick leave, personal days and summer flex time
Company equity
Bonus program
401(k) plan with company match
Access to on-demand legal and financial advice
Learning and development programs to help you grow professionally and a mentorship program
Company social events to include annual volunteer day and donation matching
Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office