Job Information
Mako Medical Senior Reimbursement Analyst – Laboratory Billing (Remote) in Raleigh, North Carolina
Description
About the Role
We’re looking for a Senior Reimbursement Analyst to join our laboratory revenue cycle team, focused entirely on pre-claim accuracy and reimbursement readiness.
In this role, you’ll act as the final quality gate before claims are submitted — ensuring patient data, eligibility, coding, and medical necessity are correct so claims move cleanly through TELCOR, clearinghouses, and payer systems.
This is a hands-on, problem-solving role ideal for someone who enjoys digging into data, identifying root causes, and improving front-end workflows to prevent downstream denials.
What You’ll Be Responsible For
Pre-Claim Review & Accuracy
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
Eligibility & Coverage Analysis
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
Recommend front-end process improvements to reduce eligibility-related errors
Clearinghouse & Pre-Adjudication Support
Review claim acknowledgments, clearinghouse reports, and payer responses
Analyze and resolve pre-submission rejections related to formatting, coding, or payer edits
Work with clearinghouse partners to troubleshoot recurring rejection patterns
Partner with operations teams to ensure accurate claim creation and routing
TELCOR System Support
Use TELCOR to review claims, data feeds, file processing issues, and mapping errors
Troubleshoot order imports, payer mapping, demographic ingestion, and coverage files
Identify systemic TELCOR issues that cause recurring pre-claim errors
Collaborate with IT, billing, and analytics teams to resolve interface or data-pipeline issues
Data Analysis & Reporting
Use SQL to investigate missing data, eligibility mismatches, and payer configuration issues
Identify trends in pre-claim errors to support process improvements
Contribute to reporting, dashboards, or automated audits that improve claim quality
What We’re Looking For
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 (Not Required)
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
We encourage candidates who meet most — but not all — qualifications to apply.
Why Join Us
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
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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