Lead Claims Analyst (Healthcare)

Location: Remote

Salary: $60,000–$80,000 per year, plus bonus eligibility, equity incentive, and benefits.

Company

hirify.global provides concierge access to a premium radiology network of more than 5,000 vetted providers across 48 states, helping patients, employers, and payers reduce imaging costs and avoid surprise bills.

What you will do

• Own claims review, validation, adjudication, and quality assurance against benefit designs, contracted rates, and pass-through payment rules.
• Investigate denials and underpayments, manage appeals and resubmissions, and identify upstream fixes across prior authorization, eligibility, and EDI configuration.
• Manage Waystar clearinghouse workflows, including 837P submissions, 835 remittances, companion-guide requirements, rejections, and payer-specific edits.
• Safeguard deductible, coinsurance, HDHP, cost-share, and accumulator accuracy while maintaining compliance with cost-sharing rules.
• Monitor accounts receivable and claims aging, prioritize collectible balances, and build reporting on adjudication turnaround, denial rates, clean-claim rates, recovery, and AR aging.
• Coordinate with prior authorization, finance, and client-facing teams while documenting SOPs, edits, escalation paths, and analyst training materials.

Requirements

• At least 4 years of experience in healthcare claims, revenue cycle, or medical billing, including complex adjudication and denials work.
• Hands-on experience with 837/835 EDI transactions and a clearinghouse platform; Waystar experience is strongly preferred.
• Strong knowledge of CPT/HCPCS, ICD-10, place-of-service, and modifier logic, ideally within radiology or imaging.
• Working knowledge of benefit structures, cost-sharing, deductibles, accumulators, and HDHP mechanics.
• Advanced spreadsheet skills and the ability to build reporting from raw claims data.
• Meticulous, audit-minded approach with the ability to trace payments and claims amounts to their source.

Nice to have

• Experience with a TPA, benefits administrator, or payer serving self-funded employers.
• Familiarity with prior authorization workflows and tools such as Infinx.
• Experience with appeals, payer escalations, and underpayment recovery at scale.
• Experience in an early-stage or high-growth environment where processes must be built from the ground up.

Culture & Benefits

• Remote work environment.
• Bonus eligibility in addition to base salary.
• Participation in an equity incentive plan.
• Competitive benefits plans.