Technical Denials Analyst

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

📋 Description

• Act as the subject matter expert for technical denials across commercial, Medicare, Medicaid, and managed care payers.

• Recognize recurring trends by payer, department, facility, denial reason, and business function, including billing, credentialing, claim submission, registration, and eligibility issues.

• Facilitate cross-functional working sessions with billing, patient access, credentialing, EDI, and other revenue cycle teams.

• Validate findings, identify root causes, outline operational remediation steps, and assist in implementation.

• Track denial, rejection, and processing trends across payers and departments.

• Prioritize categories and accounts with the most significant operational or financial implications.

• Escalate substantial changes and emerging risks.

• Maintain ongoing reporting on technical denial rates, trends, resolution timeliness, and recovery outcomes.

• Evaluate if operational improvements are successfully decreasing recurrence.

• Document insights, recommendations, and agreed-upon operational actions.

• Follow up with responsible teams when outcomes do not improve or denials persist.

• Advise revenue cycle and client leadership regarding technical denial risks, payer changes, and recommended priorities.

• Utilize, protect, and disclose patients’ PHI in accordance with HIPAA standards.

• Adhere to Information Security and HIPAA policies and procedures.

• Limit access to PHI to the minimum necessary.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, business, finance, or a related field; a combination of education and progressive revenue cycle experience may 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 understanding of commercial, Medicare, Medicaid, and managed care payer requirements, including common claim submission, processing, and denial regulations.

• Capacity to analyze denial data and recognize significant patterns by payer, department, facility, denial reason, or business office function.

• Proven ability to identify root causes, guide cross-functional teams through operational remediation, and maintain results without day-to-day supervision.

• Strong working knowledge of CARC/RARC denial and remark codes and the 837/835 claim lifecycle.

• Comfortable working with large claims/remittance data sets.

• Experience with multiple payer portals, clearinghouse platforms, or patient accounting systems is preferred.

• Familiarity with SQL or BI tools for claims analysis is preferred.

• Experience supporting denial analysis across various facilities, departments, or payer types is preferred.

• Proficient in Microsoft Office Suite, with advanced Excel skills.

• Strong interpersonal and influencing skills, with the capability to communicate and present findings at all levels of the organization, including executive leadership.

• Excellent problem-solving and creative skills, with the ability to exercise independent judgment and make decisions based on accurate and timely analyses.

• High level of integrity and reliability, with a strong sense of urgency and results-oriented mindset.

• 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.

🏝️ Benefits

• Occasional travel to client facility sites may be necessary.

• Ability to work outside of standard business hours to support special projects.

• Smartphone or electronic device capable of downloading applications will be provided or required for multifactor authentication and security purposes.