The Health Alliance logo
The Health Alliance

Value-Based Care

Senior Reimbursement Analyst – Laboratory Billing

AnalystAnalystFull TimeRemoteSeniorTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

North Carolina

Posted

93 days ago

Salary

0

Seniority

Senior

Bachelor DegreeEnglishSQL

Job Description

Senior Reimbursement Analyst – Laboratory Billing

The Health Alliance

• 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 • 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 • Review claim acknowledgments, clearinghouse reports, and payer responses • Analyze and resolve pre-submission rejections related to formatting, coding, or payer edits • Use TELCOR to review claims, data feeds, file processing issues, and mapping errors • Identify systemic TELCOR issues that cause recurring pre-claim errors • Use SQL to investigate missing data, eligibility mismatches, and payer configuration issues

Job Requirements

  • 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 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

Benefits

  • 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

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