Data Management Analyst, Denials AI

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.
Originally posted on Himalayas