Claims Analyst
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Job Summary
Owning the day-to-day integrity of claims and adjudication workflows, the remote Claims Analyst will manage complex claims and denials, develop reporting processes, and ensure compliance with cost-sharing rules while working closely with various teams.
Key responsibilities
- Review, validate, and adjudicate imaging claims against benefit designs and contracted rates, addressing discrepancies proactively
- Investigate root causes of denials and underpayments, driving appeals and building analyses to prevent future issues
- Develop and maintain dashboards and KPIs from claims data to provide real-time insights to finance and leadership
Required qualifications
- 2+ years in healthcare claims, revenue cycle, or medical billing with experience in complex adjudication and denials
- Hands-on experience with EDI transactions (837/835) and familiarity with a clearinghouse platform, preferably Waystar
- Strong knowledge of CPT/HCPCS, ICD-10, and benefit structures related to radiology/imaging
- Advanced spreadsheet skills for building reports from raw claims data
- Meticulous, audit-minded approach to tracing and defending financial data
Complete Job Description
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