Carrier Revenue Analyst

PROGYNY; New York (NY); Sur place; USD 65 000 - 70 000; Plein temps

Avantages offerts par ce poste

Health insurance

401(k) plan with company match

Paid time off

Equity

Bonus program

Onsite meals and snacks

Office commuter benefits

Résumé du poste

Progyny in New York, NY is seeking a Carrier Revenue Analyst to support backend RCM operations, focusing on claims investigation, denial resolution, and revenue recovery. You will analyze claims across commercial payors and drive remediation with internal teams and external carriers.

The ideal candidate has 1+ year of healthcare RCM or claims processing experience, with expertise in claim adjudication workflows, denial management, and reimbursement methodologies.

Qualifications

• 1+ year of healthcare RCM or claims processing experience.
• Knowledge of 837, 835, 277/276 and EOB interpretation.
• Experience with denial investigation, appeals, and corrections.
• Strong Excel data analysis and pivot tables skills.
• Understanding of CPT/HCPCS coding and payer workflows.

Responsabilités

• Investigate denials and recoupment opportunities, categorize issues.
• Conduct root cause analysis across eligibility, COB, and coding.
• Collaborate with payors and internal teams to drive reprocessing.
• Reconcile payments using 835/EOB data and monitor unapplied cash.
• Develop reports and dashboards tracking denial rates and NR, AR aging.

Connaissances

Claims review

Root cause analysis

Excel proficiency

SQL

Payor communications

Data analysis

Communication

Formation

Bachelor's degree or equivalent

Outils

Power BI

Description du poste

Thank you for considering Progyny!

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.

Working knowledge of:

• Claims lifecycle (837, 835, 277/276, EOB interpretation).
• Experience working with commercial carriers (e.g., Aetna, Anthem, UHC, etc.).
• CPT/HCPCS coding.
• Commercial payor workflows and adjudication logic.
• Experience with denial investigation, appeals, and claims corrections.
• Advanced proficiency in Microsoft Excel (pivot tables, formulas, data analysis).

Experience in backend RCM functions such as:

• Denials management.
• Payment reconciliation.
• AR follow‑up.

Core Competencies

• Strong analytical and critical thinking skills with a focus on problem‑solving and root cause identification.
• High attention to detail with the ability to manage large datasets and complex claim scenarios.
• Effective communication skills, with the ability to translate findings into clear, actionable insights.
• Ability to thrive in a fast‑paced, high‑volume environment while maintaining accuracy.
• Self‑starter mindset with ownership over assigned workstreams and outcomes.

Preferred

• Familiarity with SQL or data querying tools.
• Familiarity with Clearinghouses, Provider Portals, SalesForce, Pharmacy (PBM), Medical claims.
• Exposure to reporting tools such as Power BI.

Why This Role Matters

This role plays a critical part in ensuring accurate reimbursement, minimizing revenue leakage, and improving claims performance at scale. The Carrier Revenue Analyst will directly contribute to operational excellence by identifying inefficiencies, strengthening payer relationships, and driving measurable financial outcomes.

Visa Sponsorship

Please note: Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.

Our perks

• Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents' Employee Affiliation Group.
• Menopause and midlife care.
• Health, dental, vision and life insurance options for employees and family.
• Free in‑person, virtual and text‑based mental health and wellness support.
• Paid time off, including vacation, sick leave, personal days and summer flex time.
• Company equity.
• Bonus program.
• 401(k) plan with company match.
• Access to on‑demand legal and financial advice.
• Learning and development programs to help you grow professionally and a mentorship program.
• Company social events to include annual volunteer day and donation matching.
• Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office.

Salary

In compliance with New York City's Wage Transparency Law, the annual salary range for NYC-based applicants is: $65,000 - $70,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.

Equal Opportunity Statement

Progyny is proud to be an Equal Opportunity and affirmative action employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills, and experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law.

Disability Accommodation

If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e‑mail to [e-mail].