Senior Reimbursement Analyst – Laboratory Billing (Remote)
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Job Location:
Raleigh, WV - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
About the Role
Were looking for a Senior Reimbursement Analystto join our laboratory revenue cycle team focused entirely on pre-claim accuracy and reimbursement readiness.
In this role youll act as the final quality gatebefore 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 roleideal for someone who enjoys digging into data identifying root causes and improving front-end workflows to prevent downstream denials.
What Youll 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 Were 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/)
- 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 remoterole 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
Required Experience:
Senior 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.
