Technical Denials Analyst

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