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Salary: USD 60,000 - 80,000 / annual
OneImaging is transforming radiology access by connecting patients and employers with a vetted network of 5,000+ imaging providers across 48 states, reducing costs by 60-80% while eliminating surprise bills. We're hiring a Claims Analyst to own the integrity of our claims and adjudication workflows, building the processes, controls, and reporting that enable claims operations to scale.
This is a hands-on role reporting to the Manager of Revenue Cycle Management. You'll personally adjudicate complex imaging claims, investigate denials, and develop the playbooks and dashboards that guide the team as it grows.
Key responsibilities:
- Review and adjudicate imaging claims against benefit designs, contracted rates, and pass-through payment models; resolve pricing, coding, and eligibility discrepancies
- Investigate root causes of denials and underpayments; drive appeals and resubmissions; identify upstream fixes in prior authorization, eligibility, and EDI configuration
- Work hands-on in Waystar across 837P submissions, 835 remittances, and clearinghouse workflows; troubleshoot rejections and payer-specific edits
- Ensure deductible, coinsurance, HDHP, and accumulator logic is applied correctly for accurate member and client billing and regulatory compliance
- Monitor accounts receivable and claims aging; prioritize collectible balances; maintain reporting for finance and leadership visibility
- Develop and maintain dashboards and KPIs (adjudication turnaround, denial rate, clean-claim rate, AR aging, recovery rate) from Waystar and adjacent claims data
- Coordinate across prior authorization (Infinx), finance, and client-facing teams to close the loop between authorization, exam, claim, and payment
- Document repeatable SOPs, edits, and escalation paths; mentor analysts as the team grows
Required qualifications:
- 4+ years in healthcare claims, revenue cycle, or medical billing with demonstrated ownership of complex adjudication and denials work
- Deep hands-on experience with EDI transactions (837/835) and clearinghouse platforms (Waystar strongly preferred)
- Strong command of CPT/HCPCS, ICD-10, place-of-service, and modifier logic, ideally in radiology/imaging
- Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics
- Advanced spreadsheet skills and comfort building reporting from raw claims data
- Meticulous, audit-minded approach with ability to trace dollars to source and defend findings
Preferred: TPA, benefits administrator, or payer experience; familiarity with prior authorization workflows (e.g., Infinx); exposure to appeals and underpayment recovery at scale; early-stage or high-growth environment experience.
