Lead Claims Analyst

Responsibilities

• Own claims adjudication and QA
• Lead denials management and root cause analysis
• Manage EDI and clearinghouse workflows via Waystar
• Safeguard cost-share and accumulator accuracy
• Monitor accounts receivable and claims aging
• Develop and maintain reporting dashboards and KPIs
• Coordinate across prior authorization and finance teams
• Document repeatable SOPs and mentor analysts

Requirements

• 4+ years in healthcare claims, revenue cycle, or medical billing
• Deep hands-on experience with EDI transactions (837/835)
• Proficiency with clearinghouse platforms like Waystar
• Strong command of CPT/HCPCS, ICD-10, and modifier logic
• Working knowledge of benefit structures and cost-sharing
• Advanced spreadsheet skills
• Meticulous, audit-minded approach

Preferred Qualifications

• Experience at a TPA, benefits administrator, or payer
• Familiarity with prior authorization tools like Infinx
• Exposure to appeals and underpayment recovery at scale
• Experience in early-stage or high-growth environments

About the Company

OneImaging provides a concierge approach to radiology services, reducing imaging costs by 60-80% through a premium-quality network of vetted providers.