Job Description
Carrier Revenue Analyst 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. What You'll Do... 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 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 Reconcile payments using 835/EOB data to ensure accurate posting and identify discrepancies Monitor and track unapplied cash, posting errors, and claim status gaps 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 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 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, and Aging AR and recovery progress Provide actionable insights to leadership on revenue leakage and operational inefficiencies About You... 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, or AR follow-up Extensive 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 Nice To Have... 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 Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. 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. About Progyny Progyny (Nasdaq: PGNY) is a global leader in women's health and family building solutions, trusted by the nation's leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the