Medical Reviewer – Laboratory Specialist

Job Description:

• Review laboratory-related claims, Treatment Authorization Requests (TARs), orders, and supporting documentation
• Evaluate laboratory services based on applicable medical policies, coverage requirements, and program guidelines
• Apply laboratory expertise to review the appropriateness of requested or billed laboratory services
• Support claim adjudication and medical review activities involving laboratory testing
• Review documentation for completeness and alignment with program requirements
• Document review findings, decisions, and supporting rationale accurately and timely
• Identify documentation, billing, or coverage issues requiring additional review or clarification
• Collaborate with clinical, operational, provider-facing, and Medical Review Services teams
• Maintain knowledge of laboratory practices, medical policies, coverage requirements, and healthcare program guidelines
• Meet established quality, accuracy, productivity, and turnaround-time expectations
• Navigate multiple computer systems and applications to complete reviews and document findings
• Support timely determinations for California healthcare programs

Requirements:

• Minimum of two (2) years of experience as a laboratory technician
• High school diploma or equivalent
• Completion of a Medical Laboratory Technician program from an accredited medical laboratory technician school
• Knowledge of laboratory procedures, terminology, testing, and documentation
• Ability to interpret laboratory-related records, orders, claims, and supporting documentation
• Strong analytical, written, and verbal communication skills
• Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams
• Maintain all professional certifications and credentials required for the position in active and good-standing status, as applicable

Benefits:

• Flexible hours
• Work-life balance
• Continuous learning and career development
• Remote work environment
• Flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies
• Ongoing training and support
• 0–10% travel requirement

Apply To This Job