Revenue Cycle Denials Analyst

LE001 Richmond Medical Center; New York (NY); On-site; USD 60,000 - 70,000; Full time

Job summary

Richmond University Medical Center in New York is seeking a Denials Analyst/Manager to monitor and reduce hospital denial workflows across payers. You will analyze denial patterns, prepare dashboards, and partner with clinical and billing teams to drive prevention rather than recovery.

The role requires 3+ years in hospital revenue cycle or denial management, familiarity with UB-04, CARC/RARC codes, and system experience (Meditech, Epic). Salary ranges are $60,000-$70,000 with full benefits.

Qualifications

• Associate’s or Bachelor’s degree preferred; 3+ years hospital revenue cycle/denial management experience.
• Proficient in Excel and denial/billing systems (Meditech, Epic).
• Familiarity with UB-04 facility billing, CARC/RARC codes, OPPS/APC/DRG methodologies is preferred.

Responsibilities

• Monitor denial work queues and categorize rejects across payers.
• Perform trend analysis and root-cause identification.
• Prepare denial dashboards showing volume, dollar impact, aging and trends.
• Support Denials Steering Committee with data and action items.
• Help implement workflows to reduce denial root causes and improve processes.
• Provide analytical support to downstream teams for payer audits.
• Ensure data integrity and compliance with internal policies.

Skills

Analytics

Excel

Denial systems

Payer rules

Education

Associate/Bachelor degree

Tools

Meditech

Epic

Job description

Overview

It\'s fun to work in a company where people truly BELIEVE in what they\'re doing! We\'re committed to bringing passion and customer focus to the business. Day Shift - 7.5 Hours (United States of America).

Responsibilities

• Denial Monitoring, Review & Tracking: Monitors denial work queues for facility (technical) billing across all payers. Reviews daily, weekly, and monthly denial reports by payer, denial type, and financial impact. Categorizes denials consistently using standardized HFMA and internal definitions. Analyzes CARC/RARC codes to determine root causes and required next steps. Investigates underlying issues such as registration errors, eligibility, authorization, coding, medical necessity, billing edits, and payer-specific requirements. Maintains a centralized denial log that includes denial category, status, actions taken, and financial implications.
• Trend Analysis & Root-Cause Identification: Performs trend analysis to identify patterns, spikes, or recurring issues. Differentiates avoidable vs. unavoidable denials and reports preventable causes. Conducts root-cause analysis and escalates systemic issues to Revenue Integrity. Evaluates upstream workflow breakdowns (registration errors, auth gaps, documentation issues, coding discrepancies, etc.).
• Reporting: Prepares regular denial dashboards showing denial volume by category and payer, dollar impact, aging and trends over time, and avoidable vs. unavoidable breakdowns. Produces actionable insights for leadership and operational teams. Ensures reporting aligns with the hospital\'s standardized denial management framework.
• Governance: Provides data, summaries, and insights for the Denials Steering Committee and associated Workgroups. Tracks progress on Performance Improvement Plans (PIPs) and action items owned by various departments. Partners with Business Owners to review trends and monitor corrective actions. Helps reinforce accountability by documenting follow-up items and escalating barriers. Supports the overall shift from denial recovery to denial prevention.
• Process Improvement: Works with Patient Access, Coding, Utilization Review, Billing, Managed Care, and clinicians to reduce denial root causes. Participates in workflow reviews, education efforts, and operational redesign related to denials prevention. Supports implementation and post-implementation monitoring of improvement initiatives.
• Payer & Audit Support: Monitors payer policy and regulatory updates as they relate to denials. Provides denial samples, data, and trend summaries for payer escalation or audit review. Does not perform appeals but provides analytical support to downstream teams who do.
• Compliance & Data Integrity: Ensures data accuracy, consistency, and compliance with internal policies, CMS, HIPAA, and payer requirements. Validates denial data regularly to ensure reliability of reporting dashboards.

Requirements

• Education & Experience: Associate’s or Bachelor’s degree preferred. Minimum 3 years of hospital revenue cycle or denial management experience. Familiarity with UB-04 facility billing, payer remits, CARC/RARC codes, and OPPS/APC/DRG methodologies strongly preferred.
• Skills & Knowledge: Strong analytical and data interpretation skills. Proficient in Excel and denial/billing systems (e.g., Meditech, Epic). Understanding of Medicaid, Medicare, and commercial payer denial rules. Ability to communicate effectively across clinical and administrative departments. High attention to detail, accuracy, and organizational skills.

Compensation & Benefits

Salary Range: $60,000 - $70,000 (Commensurate with Experience)

Equal Employment Opportunity

Employment Non-Discrimination: Richmond University Medical Center is committed to equality of opportunity in all aspects of employment and provides full and equal employment opportunities to all employees and potential employees without regard to race, color, national origin, religion, gender identity, sex, sexual orientation, pregnancy, childbirth and related medical conditions and needs including lactation accommodations, physical or mental disability, age, immigration or citizenship status, veteran or active military status, genetic information, or any other legally protected status.

We are Welcoming, Energized, Compassionate, Advocates, Respectful and Excellent in our interaction with our patients, families, visitors and co-workers.