Medical Reviewer, Laboratory Specialist

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $50k - $60k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Review laboratory-related claims, Treatment Authorization Requests (TARs), orders, and supporting documentation • Evaluate laboratory services based on applicable medical policies, coverage requirements, and program guidelines • Apply laboratory expertise when reviewing the appropriateness of requested or billed laboratory services • Support claim adjudication and medical review activities involving laboratory testing • Review documentation for completeness and alignment with program requirements • Document review findings, decisions, and supporting rationale accurately and timely • Identify documentation, billing, or coverage issues requiring additional review or clarification • Collaborate with clinical, operational, provider-facing, and other Medical Review Services teams • Maintain knowledge of laboratory practices, medical policies, coverage requirements, and healthcare program guidelines • Navigate multiple computer systems and applications to complete reviews and document findings • Meet established quality, accuracy, productivity, and turnaround-time expectations • Work primarily from a home office supporting California healthcare programs

🎯 Requirements

• Minimum of two (2) years of experience as a laboratory technician • High school diploma or equivalent • Completion of a Medical Laboratory Technician program from an accredited medical laboratory technician school • Knowledge of laboratory procedures, terminology, testing, and documentation • Ability to interpret laboratory-related records, orders, claims, and supporting documentation • Strong analytical, written, and verbal communication skills • Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams • Maintain all professional certifications and credentials required for the position in active and good-standing status, as applicable

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Ongoing training and support • Remote work environment • 0–10% travel requirement