Carrier Revenue Analyst

Job description

Thank you for considering Progyny!

We areseekinga detail-oriented and analyticalCarrier Revenue Analyst to support backend Revenue Cycle Management (RCM) operations, with a strong focus on claims investigation, denial resolution, and revenue recovery.

This roleis responsible fordeep-dive analysis of claims across commercial payors,identifyingroot causes of payment discrepancies, and driving resolution through internal remediation and external carrier engagement.

The ideal candidate brings at least 1+yearof healthcare claims processing or RCM experience, witha strong foundationin claim adjudication workflows, denial management, and reimbursement methodologies.

Key Responsibilities

Claims Investigation & Root Cause Analysis

Perform detailed review of claims lifecycle (submission through adjudication) toidentifydenials, 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

Identifytrends and systemic issuesimpactingreimbursement and recommend scalable remediation strategies

Backend RCM Operations

Reconcile payments using 835/EOB data to ensureaccurateposting andidentifydiscrepancies

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, ensuringtimelyfollow-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

Supportrebillworkflows byvalidatingcorrected 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 andmaintainreports and dashboards to track:

Denial rates

First-pass resolution

Net collection rate

Aging AR and recovery progress

Provideactionable 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

Advancedproficiencyin 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 whilemaintainingaccuracy

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 ensuringaccuratereimbursement, minimizing revenue leakage, and improving claims performance at scale. The Carrier Revenue Analyst will directly contribute to operational excellence byidentifyinginefficiencies, strengthening payer relationships, and driving measurable financial outcomes.

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

Our mission is toempower 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 .

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 eventsto 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

In compliance with New York City's Wage Transparency Law, the annual salary (wage) range for NYC-based applicants is: $65,000 - $70,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.

Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law.

If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to .

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Who can apply

Review the original listing for work authorization, qualifications and employer requirements.