Senior Reimbursement Analyst – Laboratory Billing

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🕒 Março 28

🌲 North Carolina – Remoto

🌲 North Carolina – Remote

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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The Health Alliance

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

💊 Farmacêutico

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

A Health Alliance é uma rede nacional de serviços de saúde que oferece soluções integradas de cuidados primários e cuidados de saúde patrocinados por empregadores. Ela opera clínicas avançadas de cuidados primários e clínicas in loco, proporciona modelos de cuidados baseados em valor, e faz parcerias com grupos de patologia, laboratórios clínicos, PBMs, farmácias, organizações de pesquisa clínica e empresas de sangue/plasma. Com uma grande e crescente equipe e alcance em todo o território nacional, a organização foca na entrega coordenada de cuidados e parcerias para atender empregadores e sistemas de saúde.

Descrição

• 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

🎯 Requisitos

• 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

🏖️ Benefícios

• 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