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. 

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 leadership on revenue leakage and operational inefficiencies  

Qualifications

Required 

• 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  

• AR follow-up  

Core Competencies 

• Strong 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  

Preferred 

• 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  

Why This Role Matters 

This role plays a critical part in ensuring accurate reimbursement, minimizing revenue leakage, and improving claims performance at scale. The Carrier Revenue Analyst will directly contribute to operational excellence by identifying inefficiencies, strengthening payer relationships, and driving measurable financial outcomes. 

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 latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.   

Our mission is to empower healthier, supported journeys through transformative fertility, family building and women’s health benefits.   

Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.  

  Our perks:   

• Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation Group  

• Menopause and midlife care 

• Health, dental, vision and life insurance options for employees and family   

• Free in-person, virtual and text-based mental health and wellness support   

• Paid time off, including vacation, sick leave, personal days and summer flex time   

• Company equity   

• Bonus program   

• 401(k) plan with company match 

• Access to on-demand legal and financial advice    

• Learning and development programs to help you grow professionally and a mentorship program 

• Company social events to include annual volunteer day and donation matching 

• Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office