Analyst, Denials Management

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

The Analyst, Denials Management plays a critical role in supporting Denials Management and revenue integrity functions by reviewing, analyzing, and estimating reimbursement across clinical, technical, and DRG‑related denials. This position conducts daily client transaction reviews, calculates expected payments and Corro reimbursement, and partners closely with the invoicing team to ensure accurate and timely invoicing. The role also identifies payer and referral trends, monitors denial patterns, supports appeal strategies in collaboration with clinical and coding teams, and develops monthly and quarterly forecasts to guide operational and financial decision‑making. Strong analytical skills, advanced Excel capabilities, and experience with DRG downgrades and denials workflows are essential to success in this role.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Location: Remote within US Only

We’re seeking a detail‑oriented Analyst, Denials Management to support our Denials Management team in accurately estimating client reimbursement, performing invoicing with a strong focus on quality assurance, and strengthening client health and satisfaction, while also integrating referral and payer trend insights.

This role entails the daily review of client transactions, including calculating expected payments and Corro reimbursement. Payment review within the client’s system may be required, and experience with Epic is a plus. The ideal candidate has hands‑on DRG downgrade experience and exposure to both clinical and technical denials management. Strong Excel skills—including VLOOKUPs and pivot table creation—along with working knowledge of invoicing and billing are essential. Experience with Power BI is also a plus.

In this role, you will partner with our invoicing team to advise on what should be invoiced and build monthly/quarterly forecasts of projected collections, while also flagging referral issues such as payer delays, coding denials, or edits that may impact yield.

Key Responsibilities:

• Daily Reconciliation & Estimation
  • Ingest and reconcile daily client transaction files with internal systems (Prism, Escort) and worked account inventories.
  • Estimate expected reimbursements and invoiceable amounts by account, payer, and denial type.
  • Provide clear estimation files or dashboards to the Invoicing team, with rationale and assumptions.
• Denials Management
  • Review clinical and technical denials, including DRG downgrades, and apply payer policies and historical outcomes to estimate likelihood and timing of reimbursement.
  • Identify cases needing escalation (e.g., medical necessity, coding edits, DRG validation) and coordinate with appeals or clinical review teams.
• Forecasting & Reporting
  • Develop and maintain monthly and quarterly cash/reimbursement forecasts at payer, facility, and portfolio levels.
  • Track variance to forecast and refine assumptions using observed trends (win rates, overturn rates, average days to pay, partial approvals).
  • Build recurring reporting packages and visuals (Excel and/or Power BI) for leadership and Finance.
• Payer Trend Analytics
  • Monitor payer behavior for delays, systemic edits, code issues, and policy changes; quantify impact and recommend mitigations.
  • Surface trends in approval rates, denial reasons, DRG downgrade patterns, and recovery cycles.
• Data Quality & Process Improvement
  • Validate file integrity, ensure alignment of account identifiers, transaction types, and adjustments.
  • Partner with Product/IT on Prism/Escort enhancements and data hygiene; document SOPs for repeatable analyses.
• Daily Reconciliation & Estimation
  • Ingest and reconcile daily client transaction files with internal systems (Prism, Escort) and worked account inventories.
  • Estimate expected reimbursements and invoiceable amounts by account, payer, and denial type.
  • Provide clear estimation files or dashboards to the Invoicing team, with rationale and assumptions.

Required Qualifications:

• 2–5 years in revenue cycle, denials management, reimbursement analysis, payer operations, or related healthcare finance role.
• Direct experience with DRG downgrades and denial categories (clinical & technical) and how they impact reimbursement.
• Proficiency in Microsoft Excel (vlookups/xlookups, index/match, pivot tables, text functions, basic formulas, conditional logic; light macros a plus).
• Experience reconciling daily transaction files and working with internal case/account systems (experience with Prism and Escort strongly preferred).
• Familiarity with invoicing/billing concepts (EOB/ERA basics, adjustments, takebacks, net vs gross)
• Ability to build monthly/quarterly forecasts and explain assumptions and variance drivers.
• Strong attention to detail, data validation mindset, and clear written communication.

Preferred Qualifications:

• Experience using Power BI (building basic reports, slicers, measures, and data models).
• Knowledge of payer policies, coding principles (ICD-10-CM/PCS, DRG logic), and revenue integrity.
• Exposure to appeals workflows, overturn rates, and common payer edit logic.
• SQL basics or comfort working with large datasets (nice to have, not required).

Physical Demands:

Note: Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions as described.

Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.