Value-Based Care
Senior Reimbursement Analyst – Laboratory Billing
Location
North Carolina
Posted
93 days ago
Salary
0
Seniority
Senior
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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