Uncovering Revenue Leakage in Hospital Claims

This project analyzes healthcare claims data to uncover patterns behind claim denials and their financial impact on healthcare organizations. Using PostgreSQL for data cleaning, Python for exploratory and statistical analysis, and Power BI for visualization, the project investigates denial rates across departments, providers, payer types, and diagnosis categories.

The analysis identifies key operational drivers of denials, quantifies revenue leakage, highlights high-risk provider-diagnosis combinations, and develops a rule-based denial risk flag to support proactive intervention. The findings provide actionable insights that can help reduce revenue loss and improve claims management processes.

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