RCM Analyst

We’re looking for a detail-driven RCM Analyst to join our revenue cycle team and sit at the intersection of analytics and operations. This role is built for a proactive problem-solver who possesses the technical skill to identify abnormalities in complex datasets and the industry grit to navigate payer portals and phone trees to find answers. You will own the lifecycle of a denial from root-cause identification to final resolution, translating systemic trends into process improvements and turning investigative findings into recoverable revenue.

Responsibilities

Analyze denial patterns across payers, HCPCS codes, and product lines to identify systemic root causes to aid in the development of actionable remediation strategies; Conduct direct payer outreach, calling insurance representatives, and escalating cases to discover the root cause of denials and underpaid claims; Build and maintain denial, issue, and project tracking dashboards and reporting packages that give leadership a clear view of denials, causes, and the ongoing work to fix the denials; Develop methodologies in coordination with the head of RCM for denial prioritization; Perform root cause analysis on high-volume and high-dollar denials, documenting findings and presenting recommendations; Partner with coders, billers, and front-end staff to share insights and reduce revenue leakage through upstream gaps contributing to recurring denials (eligibility, auth, coding, documentation); Monitor payer policy changes and updates, flagging impacts to current billing practices and advising on workflow adjustments; Collaborate with product and engineering to provide detailed insights into the root cause of denials and assist in crafting solutions

Requirements

3–6 years in RCM, with at least 1–2 years in a consulting or advisory capacity; Demonstrated experience working denials across commercial, Medicare, and Medicaid payers; Track record of calling payers directly, navigating payer portals, and managing the appeals lifecycle end-to-end; Proficiency in Excel / Google Sheets for data manipulation and pivot analysis; Familiarity with payer portals such as Availity; Familiarity with SQL; Experience with reporting tools or BI platforms; Working knowledge of CPT, ICD-10, and HCPCS coding conventions; Exceptional attention to detail

Benefits

Competitive benefits; Professional development opportunities; Culture that prioritizes work-life balance and continuous improvement