Senior Reimbursement Analyst – Laboratory Billing

Job not on LinkedIn

🕒 March 28

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟠 Senior

🧐 Analyst

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The Health Alliance

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

The Health Alliance is a national healthcare services network that provides integrated primary care and employer-sponsored healthcare solutions. It operates advanced primary care and on-site clinics, delivers value-based care models, and partners with pathology groups, clinical laboratories, PBMs, pharmacies, clinical research organizations, and blood/plasma companies. With a large, growing team and nationwide reach, the organization focuses on coordinated care delivery and partnerships to serve employers and health systems.

📋 Description

• 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

🎯 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