Analyst, Denials Management

Key Responsibilities:

• Ingest and reconcile daily client transaction files with internal systems.
• Estimate expected reimbursements and invoiceable amounts by account, payer, and denial type.
• Provide clear estimation files or dashboards to the Invoicing team.

Denials Management:

• Review clinical and technical denials, including DRG downgrades.
• Identify cases needing escalation and coordinate with appeals or clinical review teams.
• Apply payer policies and historical outcomes to estimate likelihood and timing of reimbursement.

Forecasting & Reporting:

• Develop and maintain monthly and quarterly cash/reimbursement forecasts.
• Build recurring reporting packages and visuals for leadership and Finance.
• Track variance to forecast and refine assumptions using observed trends.