Denials Analyst

Required Skills & Experience

-5+ years of relevant hospital or facility revenue cycle experience, preferably in collections, denials, appeals, or accounts receivable. Extensive relevant experience may be considered in lieu of a degree. -Strong hospital/facility billing experience. Candidates with only physician or professional billing experience will not be considered. -Deep knowledge of hospital denials, including authorization, COB, medical necessity, inpatient/outpatient, partial authorization, EOB/remittance, and payer-specific denials. -Strong hospital collections experience with an understanding of commercial/PPO and other payer requirements. -Ability to investigate denials, identify their root causes, and determine whether they require correction, appeal, payer follow-up, or clinical escalation. -Advanced Excel skills, including sorting and filtering large datasets, pivot tables, VLOOKUP/XLOOKUP, reporting, and trend analysis. -Previous senior or lead experience overseeing collectors or healthcare revenue cycle staff. -Ability to develop reporting for leadership and translate data into actionable denial-prevention recommendations. -Working knowledge of UB-04 facility claims and general ICD-10-CM, CPT, and HCPCS coding principles. -Associate degree in Healthcare Administration, Business Administration, Finance, or a related discipline preferred, or equivalent relevant experience.

Nice to Have Skills & Experience

-Cerner experience or Epic experience.

Job Description

Insight Global is seeking a Senior Revenue Cycle Denials Analyst to support hospital revenue cycle operations. This individual will analyze facility claim denials, identify payer and operational trends, perform root-cause analysis, and recommend denial-prevention strategies. The analyst will also provide guidance and oversight to approximately three collectors and report findings directly to revenue cycle leadership.

This is a direct-hire, non-exempt position that is fully onsite, Monday through Friday, with scheduling flexibility around 7:00 a.m. to 4:00 p.m.

Day-to-Day Responsibilities:

-Analyze hospital and facility claim denials to identify root causes, recurring patterns, payer trends, and operational barriers. -Review EOBs, ERAs, payer correspondence, claims, account documentation, and authorization information to determine appropriate resolution steps. -Evaluate authorization, COB, medical necessity, inpatient versus outpatient, partial authorization, coding/documentation, and payer-specific denials. -Determine whether accounts require correction, rebilling, appeal, payer escalation, or referral to clinical, Utilization Management, Coding, or other internal resources. -Distinguish between claim denials and underpayments and identify the appropriate follow-up process. -Create and maintain Excel reports, dashboards, and spreadsheets that communicate denial trends, root causes, recovery activity, and recommended solutions. -Develop denial-prevention recommendations rather than focusing solely on resolving individual accounts. -Work with Patient Access, Case Management, HIM, Coding, Revenue Integrity, Managed Care, and clinical teams to address recurring denial causes. -Oversee approximately three collectors, monitor productivity and quality, provide technical guidance, and assist with difficult accounts. -Present denial trends, barriers, and process-improvement recommendations to revenue cycle leadership. -Maintain accurate account documentation and meet payer-specific appeal and timely-filing deadlines.