Carrier Revenue Analyst

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 leadershi...