Claims Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate, validate, and adjudicate imaging claims in accordance with benefit designs, contracted rates, and the pass-through payment model.

• Detect and resolve discrepancies related to pricing, coding, and eligibility.

• Examine root causes of denials and underpayments, facilitate appeals and resubmissions, and analyze patterns of denial.

• Oversee EDI and clearinghouse workflows in Waystar for 837P submissions, 835 remittances, and companion-guide requirements.

• Resolve rejections and payer-specific edits while collaborating with vendors.

• Ensure the correct application of deductible, coinsurance, HDHP, and accumulator logic.

• Monitor accounts receivable and claims aging, prioritizing collectible balances.

• Create and manage dashboards and KPIs using Waystar and related claims data.

• Collaborate with prior authorization, finance, and client-facing teams across workflows related to authorization, examination, claims, and payments.

• Document SOPs, edits, and escalation procedures, while also assisting in the training and mentoring of analysts.

⛳️ Requirements

• 2+ years of experience in healthcare claims, revenue cycle management, or medical billing, demonstrating ownership of complex adjudication and denial processes.

• Extensive hands-on experience with EDI transactions (837/835) and a clearinghouse platform, preferably Waystar.

• Strong understanding of CPT/HCPCS, ICD-10, place-of-service, and modifier logic, ideally within the radiology/imaging domain.

• Familiarity with benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics.

• Advanced skills in spreadsheets and proficiency in generating reports from raw claims data.

• A detail-oriented, audit-focused mindset: capable of tracing any dollar to its source and justifying it.

• Experience working at a TPA, benefits administrator, or payer, especially in service to self-funded employers (preferred).

• Knowledge of prior authorization workflows and tools (e.g., Infinx) is preferred.

• Experience with appeals, payer escalations, and large-scale underpayment recovery is preferred.

• Prior experience in an early-stage or high-growth environment, comfortable with establishing processes where none currently exist (preferred).

🏝️ Benefits

• Eligibility for bonuses.

• Participation in an equity incentive plan.

• Comprehensive benefits packages.