Data Management Analyst, Denials AI

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Conduct daily monitoring and reconciliation of all activated DenialsAI accounts to ensure completeness and accuracy of case creation.

• Identify accounts where cases are either not being created, not advancing through workflow statuses, or failing to produce expected appeal results.

• Investigate the underlying causes of data discrepancies within the DenialsAI pipeline.

• Develop and maintain reports and dashboards that track account health, case creation success rates, and operational activity metrics.

• Communicate identified issues to engineering, operations, client services, and external stakeholders, providing supporting data and recommended categorizations.

• Monitor gap resolution metrics, including time-to-resolution, recurrence rates, and coverage percentages.

• Maintain a KPI scorecard that measures idle accounts, adherence to resolution SLA, and active account coverage.

• Define and oversee thresholds for case creation failures and operational inactivity in collaboration with operations leadership.

• Validate data accuracy in reports provided to operations and client teams.

• Utilize, safeguard, and disclose patients' protected health information solely in accordance with HIPAA standards.

• Understand and adhere to Information Security and HIPAA policies and procedures.

• Limit access to PHI to the minimum necessary to perform assigned responsibilities.

• Carry out other duties as assigned.

⛳️ Requirements

• A Bachelor’s degree in Data Analytics, Computer Science, Information Systems, Statistics, or a related field is required.

• A minimum of 3 years of experience in data analysis, preferably in the healthcare technology or revenue cycle management sectors, is required.

• Strong SQL skills, including the ability to execute complex queries across multiple data sources and large datasets.

• Experience in building reports and dashboards for operational monitoring, using tools such as Tableau, Power BI, or similar platforms.

• Familiarity with data pipelines and ETL processes, with the capability to trace data flow across system layers.

• Preferred knowledge of healthcare claims data and denial management workflows.

• Experience with AWS data services, including Athena, S3, and Glue, is preferred.

• Proficiency in Microsoft Office Suite.

• Strong interpersonal skills, with the ability to communicate effectively at all organizational levels.

• Excellent problem-solving and creative skills; capable of exercising sound judgment and making decisions based on accurate and timely analyses.

• High integrity and dependability, with a strong sense of urgency and results-driven orientation.

• Exceptional written and verbal communication skills are required.

• Must own a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

• Must be able to follow directions, collaborate with others, and manage stress effectively.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and career advancement.

• Flexible working hours and remote work options.

• Supportive and inclusive company culture.