Description:
We are seeking a detail-oriented and analytical Carrier Revenue Analyst to support backend Revenue Cycle Management (RCM) operations, with a strong focus on claims investigation, denial resolution, and revenue recovery.
This role is responsible for deep-dive analysis of claims across commercial payors, identifying root causes of payment discrepancies, and driving resolution through internal remediation and external carrier engagement.
The ideal candidate brings at least 1+ year of healthcare claims processing or RCM experience, with a strong foundation in claim adjudication workflows, denial management, and reimbursement methodologies.
Key Responsibilities
Claims Investigation & Root Cause Analysis
- Perform detailed review of claims lifecycle (submission through adjudication) to identify denials, underpayments, recoupments, and processing errors
- Conduct root cause analysis across claim issues, including eligibility, COB, coding, billing, and payer policy misalignment
- Validate claims against contracted reimbursement terms, medical policies, and billing guidelines
Denials & Revenue Recovery
- Investigate and categorize denials
- Partner with internal teams and external payors to drive reprocessing, appeals, and corrections
- Identify trends and systemic issues impacting reimbursement and recommend scalable remediation strategies
Backend RCM Operations
- Reconcile payments using 835/EOB data to ensure accurate posting and identify discrepancies
- Monitor and track unapplied cash, posting errors, and claim status gaps
Cross-Functional & Payor Collaboration
- Act as a liaison between internal teams and external carriers
- Escalate and track issues with payors, ensuring timely follow-up and resolution
- Support client and leadership requests with clear, data-driven summaries of claim performance
Compliance & Process Improvement
- Ensure adherence to HIPAA, billing compliance, and internal policies
- Contribute to process standardization and automation efforts to improve efficiency and reduce manual errors
- Participate in QA initiatives and continuous improvement of claims workflows
- Support rebill workflows by validating corrected claims and ensuring proper submission logic
Data Analysis & Reporting
- Analyze claims and financial data using Excel (required) and SQL (preferred) to uncover trends and performance gaps
- Develop and maintain reports and dashboards to track:
- Denial rates
- First-pass resolution
- Net collection rate
- Aging AR and recovery progress
- Provide actionable insights to leadership on revenue leakage and operational inefficiencies
Qualifications
Required
- Bachelor’s degree or equivalent experience
- 1+ year of healthcare RCM or claims processing experience