Lead Radiology Claims & Denials Specialist

OneImaging; Miami (FL); On-site; USD 60,000 - 80,000; Full time

Job summary

OneImaging is hiring a Lead Claims Analyst to own day-to-day integrity of claims and adjudication workflows, standing up playbooks, benchmarks, and dashboards for scale. You’ll collaborate with Waystar, Infinx, and finance to explain why a claim paid or denied, while mentoring junior analysts and shaping the process as the team grows.

The role focuses on ensuring accurate cost-sharing, AR aging, and KPI reporting, in a hands-on environment within a radiology-focused network.

Qualifications

• 4+ years in healthcare claims or revenue cycle.
• Hands-on experience with 837/835 EDI and a clearinghouse platform (Waystar preferred).
• Strong CPT/HCPCS, ICD-10, place-of-service, and modifier logic knowledge.
• Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics.

Responsibilities

• Own claims adjudication and QA; review, validate, and adjudicate imaging claims and pricing discrepancies.
• Lead denials management; investigate root causes and drive appeals and resubmissions.
• Manage EDI and clearinghouse workflows; troubleshoot rejections and partner with vendors.
• Safeguard cost-sharing and accumulator accuracy; ensure compliant billing.
• Own AR and aging; monitor receivables and provide real-time reporting to leadership.
• Build the reporting layer; develop dashboards and KPIs from Waystar data.
• Coordinate across the stack with prior authorization, finance, and client teams to close the loop.
• Write SOPs and mentor analysts as the team grows.

Skills

Claims analysis

EDI (837/835)

CPT/HCPCS knowledge

ICD-10 knowledge

Advanced spreadsheets

Audit mindset

Tools

Waystar

Infinx

Job description

OneImaging is hiring a Lead Claims Analyst to own day-to-day integrity of claims and adjudication workflows, standing up playbooks, benchmarks, and dashboards for scale. You’ll collaborate with Waystar, Infinx, and finance to explain why a claim paid or denied, while mentoring junior analysts and shaping the process as the team grows.

The role focuses on ensuring accurate cost-sharing, AR aging, and KPI reporting, in a hands-on environment within a radiology-focused network.