Data Management Analyst, Denials AI

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

📋 Description

• Oversee and reconcile all active DenialsAI accounts on a daily basis to ensure complete and accurate case creation.

• Detect accounts that lack case creation, are experiencing stalled workflow progression, or are missing expected appeal outputs.

• Examine the fundamental 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.

• Relay identified issues to engineering, operations, client services, and external parties, supported by data and suggested categorizations.

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

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

• Establish and supervise thresholds for case creation failures and operational inactivity in conjunction with operations leadership.

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

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

• Perform additional 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, ideally in healthcare technology or revenue cycle management, is required.

• Proficient SQL skills, including the capability to execute complex queries across various data sources and extensive datasets.

• Experience in creating reports and dashboards for operational monitoring using tools like Tableau, Power BI, or similar.

• Understanding of data pipelines and ETL processes, with the ability to trace data flow across system layers.

• Familiarity with healthcare claims data and denial management workflows is preferred.

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

• Proficient in Microsoft Office Suite.

• Excellent interpersonal and communication skills at all levels of the organization.

• Strong problem-solving and creative abilities; 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 orientation.

• Exceptional written and verbal communication skills are required.

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

• Ability to follow instructions, collaborate effectively with others, and manage stress.

• Capability to operate computers, peripherals, telephones, and other office equipment.

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

• Must restrict access to PHI to the absolute minimum necessary to fulfill assigned responsibilities.

🏝️ Benefits

• Opportunity for remote or virtual job arrangements.

• Support and requirement for multifactor authentication and security devices.

• Equal employment opportunity and nondiscrimination protections.