The Analyst’s Lens: Turning Patterns into Predictive Power

4 Roles, 1 Goal Series | Part 3

Revenue cycle analysts are the detectives of the healthcare financial world. While billers manage day-to-day claims, analysts dig deeper—examining trends, uncovering root causes, and translating data into actionable strategies that strengthen the entire revenue cycle. Their work isn’t just about understanding what happened yesterday; it’s about predicting and preventing tomorrow’s financial challenges. 

Bridging the gap between operational tasks and strategic decision-making, RCM analysts provide insights that protect revenue, optimize workflows, and improve performance across the organization. They serve as the linchpin between frontline teams and leadership, ensuring that patterns in claims, denials, and payments are not only understood but acted upon. 

In the third installment of our role-based denials insights series, we’re turning to the analysts behind the data—exploring how they identify trends, reveal the “why” behind denial issues, and convert insights into actionable strategies that drive a healthier, more predictable revenue cycle.

More From This Series:

• Part 1: 4 Roles, 1 Goal: How Role-Based Insights Prevent Denials and Strengthen the Revenue Cycle
• Part 2: The Biller’s Lens: Accuracy, Accountability, and Early Prevention

The RCM Analyst’s Role

Revenue cycle management is a complex ecosystem that touches every aspect of healthcare finance, from patient intake to final payment. Analysts help organizations navigate this complexity by translating data into clarity. They focus on multiple key areas: 

• Denials and Underpayments: Analysts dig into why claims are denied or underpaid, track recurring payer-specific issues, and support appeals with precise, data-driven insights. 
• Workflow Optimization: By analyzing claim submission, billing, and collection patterns, analysts highlight bottlenecks, inefficiencies, and opportunities for cross-team collaboration. 
• Financial Health Monitoring: Analysts track critical financial metrics like days in accounts receivable (AR), AR Aging, first-pass acceptance rates, and claim reprocessing volumes to safeguard cash flow and minimize revenue leakage. 

Their work ensures that the entire revenue cycle operates with visibility, precision, and predictive insight rather than relying on reactive problem-solving. 

Understanding the “Why” Behind Denials Challenges

According to the 2025 Experian Health State of Claims survey, 41 % of provider organizations report denial rates of 10 % or higher, while 54% say claim errors are on the rise and 68% report that submitting clean claims has become more challenging over the past year. 

Analysts play a critical role in making sense of these denials, tracking shifts across payers and insurance types, spotting declining appeal success or rising underpayments, and uncovering recurring errors such as coding mistakes, eligibility gaps, or missing documentation. 

In exploring the “why” behind revenue cycle challenges, denials emerge as a key puzzle piece—one that demands close attention to the metrics driving them. 

Key Metrics to Monitor for Accuracy

Tracking the right indicators allows analysts to spot trends, identify risks, and take proactive steps to prevent revenue loss. 

Some of the most important metrics include: 

• Denial rate by payer or insurance type – highlights which payer relationships may need attention. 

• Frequency of specific denial codes – uncovers recurring errors and patterns that can inform training or process improvements. 

• Appeal success rate and underpayment trends – measures the effectiveness of recovery efforts and identifies systemic issues in reimbursement. 

• Days in AR and claim reprocessing volumes – provides visibility into cash flow efficiency and rework demands. 

• AR Aging: monitors how long claims remain outstanding and identifies risks such as slow payer cycles, shifts into 60–120+ day buckets, growing pending claims or work queue backlogs, untouched claims, unresolved edit queues, and small-balance spikes that may indicate workflow or posting issues across billing, coding, or registration. 

• Rejection rates before payer processing – indicates upstream submission accuracy and potential workflow bottlenecks. 

• First-pass acceptance rate – reflects claim quality and accuracy on initial submission. 

• Rejected claim trends – monitors patterns over time to identify emerging issues before they escalate. 

By consistently monitoring these metrics, analysts can turn raw data into actionable insights, support strategic decision-making, and help their organization maintain a healthy, predictable revenue cycle. 

Red Flags to Watch For

Analysts are also responsible for spotting early warning signs that may indicate revenue loss or process breakdowns: 

• Surges in denials or spikes in specific denial codes
• Rising rejected claim trends or new reasons for delayed payments 
• Drops in appeal success rates or increases in rework volume 
• Variations in first-pass acceptance rates that suggest errors in upstream workflows 

Monitoring these trends can move an organization from a position of reactive problem-solving to one of proactive revenue cycle management. 

Acting on Denials Data: Strategies To Improve Revenue

Once the data is collected, the next step is turning insight into impact. It’s the analyst’s role to transform insights into practical strategies that protect revenue and streamline operations.

Here’s how you can help your team with data you’ve collected: 

• Identify and Analyze Spikes: When denial rates suddenly increase, investigate the underlying causes, whether they stem from coding errors, payer policy changes, or internal process issues. 

• Flag Emerging Denial Codes: Keep an eye on new denial reasons to address issues before they escalate into systemic problems. 

• Audit Underpayments Regularly: Compare expected reimbursements to actual payments to catch underpayments quickly.  

• Collaborate Across Teams: Work closely with billers, coders, and AR specialists to resolve recurring errors, improve claim submission quality, and reduce operational friction. 

• Support Appeals with Data: Provide evidence-backed insights, to strengthen appeal cases and increase recovery rates for denied or underpaid claims. 

• Recommend Process Improvements: Identify inefficiencies in workflows and suggest changes that minimize errors, accelerate collections, and enhance patient financial experiences. 

• Recurring payer errors: Watch for consistent rejection reasons from specific payers; investigate EDI or documentation rules. 

• Build Feedback Loops: Create dashboards, reports, and recurring reviews to ensure a continuous cycle of visibility, and inform leadership and operational teams so they can make proactive decisions across the revenue cycle. 

Turning Insight Into Revenue with Revco

With Revco’s real-time analytics, proprietary business intelligence, and custom reporting solutions, revenue cycle analysts can track, trend, and act on the right metrics. From identifying emerging denial codes to monitoring first-pass acceptance rates and underpayment trends, Revco empowers analysts to convert insights into action. By providing clear dashboards, predictive analytics, and collaborative reporting tools, Revco helps healthcare organizations: 

• Recover lost revenue faster
• Reduce AR aging, claim denials and rework 
• Strengthen patient financial experiences 
• Make strategic, data-driven decisions across the revenue cycle 

Revenue cycle analysts hold the keys to turning patterns into predictive power. By combining their human expertise with robust analytics tools, organizations can safeguard revenue, streamline operations, and position themselves for long-term financial health. Contact us to learn more. 

Want to continue the series? Sign up to be notified when Part 4, ‘The RCM Leader’s Lens: Aligning Teams Around Measurable Outcomes,’ goes live and learn how leadership can drive cross-team performance with actionable metrics.