Revenue Cycle Manager

Job Title: Denial Management Analyst / Revenue Cycle Analyst

Schedule: Monday – Friday, 9:00 AM – 6:00 PM

Position Summary

We are seeking an experienced Denial Management Analyst to join our Revenue Cycle team. This individual will be responsible for conducting in-depth analysis of denied healthcare claims, identifying root causes, and developing scalable solutions to reduce future denials. The ideal candidate will have strong knowledge of payer reimbursement processes, denial management workflows, CARC/RARC codes, and healthcare billing operations.

Responsibilities

• Conduct comprehensive investigations of denied claims to determine root causes and contributing factors.
• Review and interpret CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes).
• Analyze ERA/835 files, EOBs, payer responses, and supporting claim documentation.
• Identify denial drivers including authorization issues, coding errors, billing errors, registration and intake issues, payer-specific requirements, and reimbursement policy changes.
• Differentiate between preventable denials, appealable denials, and payer-driven denials.
• Document findings and develop standardized denial analysis workflows and best practices.
• Create and maintain SOPs, process documentation, and reporting standards.
• Track denial trends and identify opportunities for operational improvement and automation.
• Partner with revenue cycle, operations, product, and cross-functional teams to implement workflow enhancements.
• Prepare clear summaries, reports, and recommendations for leadership and internal stakeholders.
• Support ongoing initiatives focused on improving reimbursement performance and reducing denial rates.

Qualifications

• 3 years of experience in Revenue Cycle Management, denial management, medical billing, reimbursement, or related healthcare operations.
• Direct experience performing claim-level denial investigations and root cause analysis.
• Strong working knowledge of CARC and RARC codes.
• Experience reviewing ERA/835 files, EOBs, remittance advice, and payer correspondence.
• Understanding of payer reimbursement methodologies and denial management workflows.
• Experience using healthcare billing systems and EMRs.
• Strong analytical, documentation, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to present findings to both operational and non-technical stakeholders.

Preferred Qualifications

• Durable Medical Equipment (DME) billing experience.
• Experience with Brightree billing software.
• Exposure to multiple EMR and practice management systems.
• Background in process improvement, workflow optimization, or operational analytics.
• Experience identifying automation opportunities within revenue cycle operations.