Technical Denials Analyst

Med Metrix•Parsippany-Troy Hills, NJ

About The Position

The Technical Denials Analyst is the subject matter expert responsible for identifying and addressing the drivers of non-clinical denials across multiple payers. The analyst independently evaluates recurring trends by payer, department, facility, and denial type; determines root causes; and partners with billing, patient access, credentialing, EDI, and other revenue cycle teams to implement operational improvements that reduce recurrence. The role monitors denial, rejection, and processing trends; prioritizes issues with the greatest operational or financial impact; maintains recurring reporting on denial rates, trends, resolution timeliness, and recovery outcomes; and advises revenue cycle and client leadership on risks, payer changes, and recommended priorities. The analyst documents findings and actions, follows up on results, and complies with HIPAA and information security policies when handling protected health information. Occasional travel to client facility sites may be required. The analyst may need to work outside normal business hours for special projects and must have a smartphone or other electronic device capable of downloading applications for multifactor authentication and security. The work environment typically has minimal noise.

Requirements

Bachelor’s degree in healthcare administration, business, finance, or a related field, or an equivalent combination of education and progressive revenue cycle experience.
At least 4 years of experience in healthcare billing, claims, provider credentialing, EDI, business office, or technical denials analysis, including leading denial prevention initiatives.
Advanced knowledge of commercial, Medicare, Medicaid, and managed care payer requirements, including common claim submission, processing, and denial rules.
Ability to analyze denial data and identify meaningful patterns by payer, department, facility, denial reason, or business office function.
Demonstrated ability to identify root causes, lead cross-functional teams through operational remediation, and sustain results without day-to-day direction.
Strong working knowledge of CARC/RARC denial and remark codes and the 837/835 claim lifecycle.
Comfort working with large claims and remittance data sets.
Proficiency in Microsoft Office Suite, with strong Excel skills.
Strong interpersonal and influencing skills, including the ability to communicate and present findings at all organizational levels, including executive leadership.
Strong problem-solving and creative skills, with the ability to exercise independent judgment and make decisions based on accurate and timely analyses.
High integrity and dependability, a strong sense of urgency, and a results-oriented approach.
Excellent written and verbal communication skills.
Ability to exercise independent judgment, collaborate with others, and handle stress.
Ability to meet the described physical demands, including occasional movement around the work area, sitting, manual tasks, operating office equipment, extending arms, and kneeling.
Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

Nice To Haves

Experience working with multiple payer portals, clearinghouse platforms, or patient accounting systems.
Exposure to SQL or business intelligence tools for claims analysis.
Experience supporting denial analysis across multiple facilities, departments, or payer types.

Responsibilities

Serve as the subject matter expert for technical denials across commercial, Medicare, Medicaid, and managed care payers.
Identify recurring patterns by payer, department, facility, denial reason, and business function, including billing, credentialing, claim submission, registration, and eligibility issues.
Lead cross-functional working sessions to validate findings, determine root causes, define operational remediation steps, and support implementation.
Monitor denial, rejection, and processing trends across payers and departments; prioritize categories and accounts with the greatest operational or financial impact; and escalate material changes and emerging risks.
Maintain recurring reporting on technical denial rates, trends, resolution timeliness, and recovery outcomes, and assess whether improvements are reducing recurrence.
Document findings, recommendations, and agreed-upon operational actions; follow up with responsible teams when results do not improve or denials recur.
Advise revenue cycle and client leadership on technical denial risks, payer changes, and recommended priorities.
Perform other duties as assigned.
Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards.
Comply with information security and HIPAA policies and procedures, and limit viewing of PHI to the minimum necessary to perform assigned duties.