Mako Medical · 1 month ago
Senior Reimbursement Analyst – Laboratory Billing (Remote)
United States
Full-time
Remote
Senior LevelMako Medical is seeking a Senior Reimbursement Analyst to join their laboratory revenue cycle team, focusing on pre-claim accuracy and reimbursement readiness. In this role, you will ensure the correctness of patient data, eligibility, coding, and medical necessity before claims are submitted, while also identifying root causes of issues to improve workflows and prevent denials.
BiotechnologyHealth CareMedical
Responsibilities
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
Recommend front-end process improvements to reduce eligibility-related errors
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
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
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
Qualification
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
Company
Mako Medical
Mako Medical Laboratories, a proud member of The Health Alliance, is redefining how laboratories support patients and healthcare professionals.
Founded in 2014
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Daniel Watkins
Co-Founder
Austin Fitzwater
Chief Technology Officer
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