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About the Role

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