RCM Analyst

Verse Medical•New York, NY

3d•$130,000 - $150,000

About The Position

Verse Medical is seeking a detail-driven RCM Analyst to join their revenue cycle team. This role is positioned at the intersection of analytics and operations, requiring a proactive problem-solver with the technical skills to identify data abnormalities and the industry knowledge to navigate payer portals and phone systems. The analyst will be responsible for managing the entire denial lifecycle, from identifying root causes to final resolution, translating trends into process improvements, and recovering revenue through investigative findings.

Requirements

3–6 years in RCM, with at least 1–2 years in a consulting or advisory capacity.
Demonstrated experience working denials across commercial, Medicare, and Medicaid payers.
Track record of calling payers directly, navigating payer portals, and managing the appeals lifecycle end-to-end.
Proficiency in Excel / Google Sheets for data manipulation and pivot analysis.
Familiarity with payer portals such as Availity.
Familiarity with SQL.
Experience with reporting tools or BI platforms.
Working knowledge of CPT, ICD-10, and HCPCS coding conventions.
Exceptional attention to detail.

Responsibilities

Analyze denial patterns across payers, HCPCS codes, and product lines to identify systemic root causes for remediation strategies.
Conduct direct payer outreach, including calling insurance representatives and escalating cases, to determine the root cause of denials and underpaid claims.
Build and maintain dashboards and reporting packages for tracking denials, issues, and projects, providing leadership with clear insights.
Develop methodologies for denial prioritization in coordination with the head of RCM.
Perform root cause analysis on high-volume and high-dollar denials, documenting findings and presenting recommendations.
Partner with coders, billers, and front-end staff to share insights and reduce revenue leakage by addressing upstream gaps (eligibility, auth, coding, documentation).
Monitor payer policy changes and updates, flagging impacts to current billing practices and advising on workflow adjustments.
Collaborate with product and engineering teams to provide insights into denial root causes and assist in developing solutions.