Senior Reimbursement Analyst - Laboratory Billing (Remote)
About the RoleWere 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 youll 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 Youll Be Responsible ForPre-Claim Review & AccuracyReview lab orders and patient records to identify missing or conflicting demographic insurance or clinical dataValidate CPT and diagnosis alignment to meet payer medical necessity requirementsEnsure ordering provider information (NPI credentials facility details) is complete and accurateProactively resolve coverage and data issues before claims are generatedEligibility & Coverage AnalysisVerify insurance eligibility using 270 / 271 transactions payer portals and integrated toolsInterpret benefits exclusions and coordination of benefits that impact reimbursementIdentify and resolve inactive coverage invalid policy numbers and payer mismatchesRecommend front-end process improvements to reduce eligibility-related errorsClearinghouse & Pre-Adjudication SupportReview claim acknowledgments clearinghouse reports and payer responsesAnalyze and resolve pre-submission rejections related to formatting coding or payer editsWork with clearinghouse partners to troubleshoot recurring rejection patternsPartner with operations teams to ensure accurate claim creation and routingTELCOR System SupportUse TELCOR to review claims data feeds file processing issues and mapping errorsTroubleshoot order imports payer mapping demographic ingestion and coverage filesIdentify systemic TELCOR issues that cause recurring pre-claim errorsCollaborate with IT billing and analytics teams to resolve interface or data-pipeline issuesData Analysis & ReportingUse SQL to investigate missing data eligibility mismatches and payer configuration issuesIdentify trends in pre-claim errors to support process improvementsContribute to reporting dashboards or automated audits that improve claim qualityWhat Were Looking ForRequiredExperience in laboratory billing reimbursement or pre-claim operationsHands-on experience working with TELCOR (RCS or QML)Strong understanding of eligibility benefits and payer requirementsAbility to analyze pre-claim issues and identify root causesComfort working with data and systems to validate claim accuracyPreferred (Not Required)SQL experience for data validation or reportingFamiliarity with EDI / HL7 workflows (270 / )Experience in molecular toxicology or high-volume lab environmentsExperience building audits or automated checksWe encourage candidates who meet most but not all qualifications to apply.Why Join UsFully remote role with a specialized high-impact focusOpportunity to influence front-end revenue quality not just fix denialsCollaborative environment with IT billing and analytics teamsWork that directly improves reimbursement outcomes and operational efficiencyRequired Experience :Senior ICKey SkillsLTC Pharmacy,Accounts Receivable,Medical Coding,Accounting,10 Key Calculator,Detailing,Medical Billing,Microsoft Excel,CPT Coding,Epic,Medicare,ContractsEmployment Type :Full-TimeExperience :yearsVacancy :1. Experience: 5 years required