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 role uses independent judgment to evaluate recurring trends by payer, department, facility, and denial type; determine root causes; and partner with billing, patient access, credentialing, EDI, and other revenue cycle teams to implement operational improvements that reduce recurrence. The analyst monitors denial, rejection, and processing trends, prioritizes issues with the greatest operational or financial impact, and maintains reporting on denial rates, trends, resolution timeliness, and recovery outcomes. The role documents recommendations and operational actions, follows up on outcomes, and advises revenue cycle and client leadership on denial risks, payer changes, and priorities. Occasional travel to client facilities and work outside normal business hours for special projects may be required. The employee must comply with HIPAA and information security requirements, using and disclosing protected health information only as permitted and limiting access to the minimum necessary. The work environment is usually minimally noisy. The role involves occasional movement around the work area, sitting, manual tasks, and operating office equipment. It also requires independent judgment, collaboration, and the ability to handle stress.

Requirements

Bachelor’s degree in healthcare administration, business, finance, or a related field; an equivalent combination of education and progressive revenue cycle experience will be considered.
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 work outside normal business hours to support special projects.
Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.
Ability to exercise independent judgment, collaborate with others, and handle stress.
Ability to perform the stated physical demands, including occasional movement around the work area, sitting, manual tasks, operating office equipment, extending arms, and kneeling.

Nice To Haves

Experience 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 with billing, patient access, credentialing, EDI, and other revenue cycle teams to validate findings, determine root causes, define 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 operational improvements are reducing recurrence.
Document findings, recommendations, and agreed-upon operational actions, and 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.