Job Details

Senior Reimbursement Analyst Laboratory Billing (Remote)

We're looking for a Senior Reimbursement Analyst to join our laboratory revenue cycle team, focused entirely on pre-claim accuracy and reimbursement readiness. In this role, you'll act as the final quality gate before claims are submitted ensuring patient data, eligibility, coding, and medical necessity are correct so claims move cleanly through TELCOR, clearinghouses, and payer systems. This is a hands-on, problem-solving role ideal for someone who enjoys digging into data, identifying root causes, and improving front-end workflows to prevent downstream denials.

What You'll Be Responsible For:

Pre-Claim Review & Accuracy

• Review lab orders and patient records to identify missing or conflicting demographic, insurance, or clinical data
• Validate CPT and diagnosis alignment to meet payer medical necessity requirements
• Ensure ordering provider information (NPI, credentials, facility details) is complete and accurate
• Proactively resolve coverage and data issues before claims are generated

Eligibility & Coverage Analysis

• Verify insurance eligibility using 270/271 transactions, payer portals, and integrated tools
• Interpret benefits, exclusions, and coordination of benefits that impact reimbursement
• Identify and resolve inactive coverage, invalid policy numbers, and payer mismatches
• Recommend front-end process improvements to reduce eligibility-related errors

Clearinghouse & Pre-Adjudication Support

• Review claim acknowledgments, clearinghouse reports, and payer responses
• Analyze and resolve pre-submission rejections related to formatting, coding, or payer edits
• Work with clearinghouse partners to troubleshoot recurring rejection patterns
• Partner with operations teams to ensure accurate claim creation and routing

TELCOR System Support

• Use TELCOR to review claims, data feeds, file processing issues, and mapping errors
• Troubleshoot order imports, payer mapping, demographic ingestion, and coverage files
• Identify systemic TELCOR issues that cause recurring pre-claim errors
• Collaborate with IT, billing, and analytics teams to resolve interface or data-pipeline issues

Data Analysis & Reporting

• Use SQL to investigate missing data, eligibility mismatches, and payer configuration issues
• Identify trends in pre-claim errors to support process improvements
• Contribute to reporting, dashboards, or automated audits that improve claim quality

What We're Looking For:

Required

• Experience in laboratory billing, reimbursement, or pre-claim operations
• Hands-on experience working with TELCOR (RCS or QML)
• Strong understanding of eligibility, benefits, and payer requirements
• Ability to analyze pre-claim issues and identify root causes
• Comfort working with data and systems to validate claim accuracy

Preferred (Not Required)

• SQL experience for data validation or reporting
• Familiarity with EDI / HL7 workflows (270/271, 837, 835)
• Experience in molecular, toxicology, or high-volume lab environments
• Experience building audits or automated checks

We encourage candidates who meet most but not all qualifications to apply.

Why Join Us

• Fully remote role with a specialized, high-impact focus
• Opportunity to influence front-end revenue quality, not just fix denials
• Collaborative environment with IT, billing, and analytics teams
• Work that directly improves reimbursement outcomes and operational efficiency

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.