Claims Analyst

Responsibilities

• Review, validate, and adjudicate imaging claims against benefit designs and contracted rates
• Investigate root causes of denials and underpayments and drive appeals and resubmissions
• Work hands-on in Waystar across 837P submissions, 835 remittances, and rejections
• Ensure deductible, coinsurance, HDHP, and accumulator logic is applied correctly
• Monitor accounts receivable and claims aging and maintain reporting for finance and leadership
• Build dashboards and KPIs for adjudication turnaround, denial rate, and clean-claim rate
• Document SOPs, edits, and escalation paths and mentor analysts

Requirements

• 2+ years in healthcare claims, revenue cycle, or medical billing
• EDI transactions (837/835) and clearinghouse experience
• CPT/HCPCS, ICD-10, place-of-service, and modifier logic
• Benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics
• Advanced spreadsheet skills and reporting from raw claims data
• Meticulous, audit-minded approach

Preferred Qualifications

• TPA, benefits administrator, or payer experience
• Prior authorization workflows and tools (e.g., Infinx)
• Appeals, payer escalations, and underpayment recovery
• Early-stage or high-growth environment experience

About the Company

OneImaging offers a concierge radiology network of over 5,000 vetted providers across 48 states, reducing imaging costs for patients, employers and payers.