Lead Claims Analyst

OneImaging is transforming the radiology landscape by providing a concierge approach to medical imaging, connecting patients with a premium network of providers while significantly reducing costs. We are seeking a Lead Claims Analyst to oversee the integrity of our claims and adjudication workflows, ensuring operational excellence as we scale our services.

Key responsibilities

• Own claims adjudication and quality assurance by validating imaging claims against benefit designs and contracted rates.
• Lead denials management by investigating root causes, driving appeals, and implementing fixes to prevent future issues.
• Manage EDI and clearinghouse workflows, including troubleshooting 837P submissions and 835 remittances.
• Safeguard cost-share and accumulator accuracy to ensure compliant and precise billing for members and clients.
• Develop and maintain reporting dashboards and KPIs to provide real-time visibility into claims performance and AR aging.

Requirements

• At least 4 years of experience in healthcare claims, revenue cycle management, or medical billing.
• Deep hands-on expertise with EDI transactions and clearinghouse platforms, with a strong preference for Waystar.
• Comprehensive knowledge of CPT, HCPCS, ICD-10, and modifier logic, ideally within the radiology sector.
• Advanced spreadsheet skills and the ability to build reporting structures from raw claims data.
• A meticulous, audit-minded approach with the ability to trace financial data to its source.

What we offer

• Opportunity to work in a high-growth environment where you can build processes from the ground up.
• Competitive compensation package including base salary and bonus eligibility.
• Participation in equity incentive plans and comprehensive benefits.
• A fully remote work environment that values diversity and equal opportunity.