Data Management Analyst, Denials AI

Med-Metrix•Parsippany-Troy Hills, NJ

About The Position

The Data Management Analyst, Denials AI ensures that cases for all activated DenialsAI accounts are successfully created and actively worked. The role performs daily data monitoring and reconciliation to identify gaps in case creation, case progression, user activity, and appeal output. It investigates discrepancies across the DenialsAI data pipeline, develops operational reports and dashboards, communicates findings to internal and external stakeholders, and tracks resolution and account-health metrics. The analyst also validates the accuracy of reports provided to operations and client teams and performs other duties as assigned. The role requires compliance with HIPAA and Information Security policies. Patient protected health information (PHI) must be used, protected, and disclosed in accordance with HIPAA standards, and access to PHI must be limited to the minimum necessary for assigned duties. The work involves use of a smartphone or other electronic device capable of downloading applications for multifactor authentication and security. Physical demands occasionally include moving around the work area, sitting, performing manual tasks, operating a computer and other office equipment, extending arms, and kneeling. The employee must be able to follow directions, collaborate, and handle stress. The work environment is usually minimally noisy.

Requirements

Bachelor’s degree in Data Analytics, Computer Science, Information Systems, Statistics, or a related field.
At least 3 years of experience in data analysis.
Strong SQL skills, including writing complex queries across multiple data sources and large datasets.
Experience building reports and dashboards for operational monitoring using Tableau, Power BI, or similar tools.
Familiarity with data pipelines and ETL processes, including the ability to trace data flow across system layers.
Proficiency in Microsoft Office Suite.
Strong interpersonal skills and ability to communicate well at all levels of the organization.
Strong problem-solving and creative skills, with sound judgment and the ability to make decisions based on accurate and timely analyses.
High integrity and dependability, with a strong sense of urgency and results orientation.
Excellent written and verbal communication skills.
Ability to use a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.
Ability to follow directions, collaborate with others, and handle stress.

Nice To Haves

Data analysis experience in healthcare technology or revenue cycle management.
Knowledge of healthcare claims data and denial management workflows.
Experience with AWS data services such as Athena, S3, and Glue.

Responsibilities

Perform daily monitoring and reconciliation of activated DenialsAI accounts to verify completeness and accuracy of case creation.
Identify accounts where cases are not being created, progressing through workflow statuses, or generating expected appeal output.
Investigate root causes of data discrepancies across the DenialsAI pipeline.
Build and maintain reports and dashboards tracking account health, case creation success rates, and operational activity metrics.
Communicate identified gaps, supporting data, and recommended categorization to engineering, operations, client services, and external stakeholders.
Track gap-resolution metrics, including time to resolution, recurrence rates, and coverage percentages.
Maintain a KPI scorecard measuring idle accounts, resolution SLA adherence, and active account coverage.
Define and monitor thresholds for case-creation failures and operational inactivity in collaboration with operations leadership.
Validate the accuracy of data in reports provided to operations and client teams.
Perform other duties as assigned.
Use, protect, and disclose PHI only in accordance with HIPAA standards; comply with Information Security and HIPAA policies; and limit PHI access to the minimum necessary.