Reimbursement Analyst (TELCOR Laboratory Billing – Pre-Claim Focus)
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Job Location:
Raleigh, WV - USA
Monthly Salary:
Not Disclosed
Posted on:
7 days ago
Vacancies:
1 Vacancy
Job Summary
About the Role
We are seeking a detail-oriented Reimbursement Analyst with strong experience in laboratory billing TELCOR SQL and eligibility/coverage analysis. This position focuses entirely on pre-claim reimbursement readinessensuring claims are correct complete medically necessary and compliant beforesubmission to payers. The ideal candidate excels at problem-solving identifying missing or invalid data and ensuring clean accurate claims flow through the TELCOR system and clearinghouse.
Key Responsibilities
Pre-Claim Readiness & Data Validation
- Review orders and patient data to identify missing incomplete or conflicting demographic insurance or clinical information.
- Validate CPT/diagnosis alignment to ensure medical necessity requirements are met prior to claim creation.
- Confirm ordering provider completeness (NPI credentials facility data etc.).
- Resolve coverage questions and discrepancies early to prevent downstream claim issues.
Eligibility Benefits and Coverage Verification
- Validate patient insurance eligibility using eligibility transactions (e.g. 270/271) payer portals or integrated tools.
- Interpret benefit details coverage limits exclusions and coordination of benefits issues that impact reimbursement.
- Flag and resolve cases related to invalid policy numbers inactive coverage or mismatched patient/payer data.
- Recommend front-end workflow improvements to minimize eligibility-related errors.
Claim Status Clearinghouse and Payer Pre-Adjudication Issues
- Review claim status responses payer acknowledgments and clearinghouse reports for missing data or rejections.
- Analyze and resolve clearinghouse rejections including formatting issues coding requirements invalid identifiers and payer-specific edits.
- Communicate with clearinghouse support teams to troubleshoot recurring edit codes or system mismatches.
- Work with operations teams to validate accurate claim creation and routing.
TELCOR System Support & Troubleshooting
- Use TELCOR to review claims data feed issues file processing errors and mapping problems that affect pre-claim integrity.
- Troubleshoot TELCOR workflows including order imports payer mapping demographic ingestion coverage files and clinical data feeds.
- Identify systemic issues within TELCOR that lead to recurring pre-claim rejections or missing fields.
- Partner with IT billing and analytics teams to resolve data pipeline or interface errors.
Data Analysis (SQL Database Work)
- Use SQL to investigate data inconsistencies missing fields eligibility mismatches and payer configuration issues.
- Query databases to identify patterns in pre-claim errors such as recurring eligibility failures or diagnosis-related edits.
- Collaborate on dashboards reporting tools or automated audits to strengthen pre-claim accuracy and throughput.
Required Qualifications
- 3 years of experience in laboratory billing reimbursement support or pre-claim operations.
- TELCOR (RCS or QML) experience with hands-on troubleshooting and workflow understanding.
- Strong problem-solving skills and the ability to diagnose complex pre-claim and data-integrity issues.
- SQL proficiency for querying and validating data across RCM LIS and eligibility systems.
- Practical experience with eligibility benefit interpretation coverage rules and payer requirements.
- Deep knowledge of laboratory billing inputs including demographics provider data diagnosis requirements and CPT-to-ICD medical necessity alignment.
- Ability to interpret payer edit codes clearinghouse rejection details and claim-status acknowledgments.
Preferred Qualifications
- Experience with HL7/EDI (especially 270/271 and 837P/835 workflows).
- Familiarity with LIS-to-TELCOR integrations and data mapping.
- Background in molecular toxicology or high-volume clinical laboratory environments.
- Experience building automated data audit checks or SQL-based validation tools.
Required Experience:
IC
Key Skills
- LTC Pharmacy
- Accounts Receivable
- Medical Coding
- Accounting
- 10 Key Calculator
- Detailing
- Medical Billing
- Microsoft Excel
- CPT Coding
- Epic
- Medicare
- Contracts
About Company
Mako Medical is a health care diagnostic laboratory specializing in helping you take control of your healthcare by offering accurate testing and quick results.
