Job Purpose The Data Management Analyst, Denials AI is responsible for ensuring all activated DenialsAI account cases are successfully created and actively being worked. The Data Management Analyst, Denials AI performs daily data monitoring and reconciliation to identify gaps in case creation, case progression, user activity, and appeal output.
Duties & Responsibilities
- Perform daily monitoring and reconciliation of all activated DenialsAI accounts to verify case creation completeness and accuracy
- Identify accounts where cases are not being created, not progressing through workflow statuses, or not generating expected appeal output
- Investigate root causes of data discrepancies across the DenialsAI pipeline
- Build and maintain reports and dashboards tracking account health, case creation success rates, and operational activity metrics
- Communicate identified gaps to engineering, operations, client services, and external stakeholders with supporting data and recommended categorization
- Track gap resolution metrics including time-to-resolution, recurrence rates, and coverage percentages
- Maintain a KPI scorecard measuring idle accounts, resolution SLA adherence, and active account coverage
- Define and monitor thresholds for case creation failures and operational inactivity in collaboration with operations leadership
- Validate data accuracy across reports provided to operations and client teams
- Other duties as assigned
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
- Bachelor’s degree in Data Analytics, Computer Science, Information Systems, Statistics, or related field required
- 3+ years of experience in data analysis, preferably in healthcare technology or revenue cycle management required
- Strong SQL skills with the ability to write complex queries across multiple data sources and large datasets
- Experience building reports and dashboards for operational monitoring (e.g., Tableau, Power BI, or similar)
- Familiarity with data pipelines and ETL processes; ability to trace data flow across system layers
- Knowledge of healthcare claims data and denial management workflows preferred
- Experience with AWS data services (Athena, S3, Glue) preferred
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills, ability to communicate well at all levels of the organizationStrong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills required
Working Conditions
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
- Work Environment: The noise level in the work environment is usually minimal
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
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