Job Purpose
The Technical Denials Analyst is the subject matter expert responsible for identifying and addressing the drivers of non-clinical denials across multiple payers. The Technical Denials Analyst 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.
Duties & 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 issues involving billing, credentialing, claim submission, registration, and eligibility
- Lead cross-functional working sessions with billing, patient access, credentialing, EDI, and other revenue cycle teams 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 use results to assess whether operational 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
- Other duties as assigned
- Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
- 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
- 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
- Comfortable with large claims/remittance data sets
- Experience working with multiple payer portals, clearinghouse platforms, or patient accounting systems preferred
- Exposure to SQL or BI tools for claims analysis preferred
- Experience supporting denial analysis across multiple facilities, departments, or payer types preferred
- Proficiency in Microsoft Office Suite, with strong Excel skills
- Strong interpersonal and influencing skills, with the ability to communicate and present findings at all levels of the organization, including executive leadership
- Strong problem solving and creative skills and the ability to exercise independent judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills required
Working Conditions
- Occasional travel to client facility sites may be required
- Ability to work outside of normal business hours to support special projects
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
- Mental Demands: The employee must be able to exercise independent judgment, collaborate with others, and handle stress
- Work Environment: The noise level in the work environment is usually minimal
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.