Own the day-to-day integrity of claims and adjudication workflows for a radiology-focused healthcare company. This hands-on role works across clearinghouse, prior authorization, and finance systems to resolve claim payment issues, denials, and underpayments while building the reporting and controls needed to scale operations.
You will personally handle complex claims, identify pricing and coding discrepancies, manage EDI and clearinghouse workflows, safeguard cost-share accuracy, monitor accounts receivable and claims aging, and develop dashboards and SOPs that improve claims operations.
Required
- 2+ years in healthcare claims, revenue cycle, or medical billing with ownership of complex adjudication and denials work
- Deep hands-on experience with EDI transactions (837/835) and a clearinghouse platform, preferably Waystar
- Strong command of CPT, HCPCS, ICD-10, place of service, and modifier logic, ideally in radiology or imaging
- Working knowledge of benefit structures, cost-sharing, deductibles, and accumulator/HDHP mechanics
- Advanced spreadsheet skills and the ability to build reporting from raw claims data
- Meticulous, audit-minded approach with the ability to trace dollars to their source
Preferred
- Experience at a TPA, benefits administrator, or payer, especially with self-funded employers
- Familiarity with prior authorization workflows and tools such as Infinix
- Exposure to appeals, payer escalations, and underpayment recovery at scale
- Experience in an early-stage or high-growth environment where processes are still being built
- Salary range: $50,000 to $65,000 annually
- Bonus eligibility
- Equity incentive eligibility
- Competitive benefits plans
Location
Miami, Florida, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$50,000 - $65,000
Remote work allowed
No
Posted
1 week ago