Reimbursement Analyst (TELCOR Laboratory Billing – Pre-Claim Focus) at The Health Alliance

About the RoleWe are seeking a detail-oriented Reimbursement Analyst with strong experience in laboratory billing TELCOR SQL and eligibility/coverage analysis. This position focuses entirely on pre-claim reimbursement readinessensuring claims are correct complete medically necessary and compliant beforesubmission to payers. The ideal candidate excels at problem-solving identifying missing or invalid data and ensuring clean accurate claims flow through the TELCOR system and clearinghouse.Key ResponsibilitiesPre-Claim Readiness & Data ValidationReview orders and patient data to identify missing incomplete or conflicting demographic insurance or clinical information.Validate CPT/diagnosis alignment to ensure medical necessity requirements are met prior to claim creation.Confirm ordering provider completeness (NPI credentials facility data etc.).Resolve coverage questions and discrepancies early to prevent downstream claim issues.Eligibility Benefits and Coverage VerificationValidate patient insurance eligibility using eligibility transactions (e.g. 270/271) payer portals or integrated tools.Interpret benefit details coverage limits exclusions and coordination of benefits issues that impact reimbursement.Flag and resolve cases related to invalid policy numbers inactive coverage or mismatched patient/payer data.Recommend front-end workflow improvements to minimize eligibility-related errors.Claim Status Clearinghouse and Payer Pre-Adjudication IssuesReview claim status responses payer acknowledgments and clearinghouse reports for missing data or rejections.Analyze and resolve clearinghouse rejections including formatting issues coding requirements invalid identifiers and payer-specific edits.Communicate with clearinghouse support teams to troubleshoot recurring edit codes or system mismatches.Work with operations teams to validate accurate claim creation and routing.TELCOR System Support & TroubleshootingUse TELCOR to review claims data feed issues file processing errors and mapping problems that affect pre-claim integrity.Troubleshoot TELCOR workflows including order imports payer mapping demographic ingestion coverage files and clinical data feeds.Identify systemic issues within TELCOR that lead to recurring pre-claim rejections or missing fields.Partner with IT billing and analytics teams to resolve data pipeline or interface errors.Data Analysis (SQL Database Work)Use SQL to investigate data inconsistencies missing fields eligibility mismatches and payer configuration issues.Query databases to identify patterns in pre-claim errors such as recurring eligibility failures or diagnosis-related edits.Collaborate on dashboards reporting tools or automated audits to strengthen pre-claim accuracy and throughput.Required Qualifications3 years of experience in laboratory billing reimbursement support or pre-claim operations.TELCOR (RCS or QML) experience with hands-on troubleshooting and workflow understanding.Strong problem-solving skills and the ability to diagnose complex pre-claim and data-integrity issues.SQL proficiency for querying and validating data across RCM LIS and eligibility systems.Practical experience with eligibility benefit interpretation coverage rules and payer requirements.Deep knowledge of laboratory billing inputs including demographics provider data diagnosis requirements and CPT-to-ICD medical necessity alignment.Ability to interpret payer edit codes clearinghouse rejection details and claim-status acknowledgments.Preferred QualificationsExperience with HL7/EDI (especially 270/271 and 837P/835 workflows).Familiarity with LIS-to-TELCOR integrations and data mapping.Background in molecular toxicology or high-volume clinical laboratory environments.Experience building automated data audit checks or SQL-based validation tools.Required Experience:IC Key Skills LTC Pharmacy,Accounts Receivable,Medical Coding,Accounting,10 Key Calculator,Detailing,Medical Billing,Microsoft Excel,CPT Coding,Epic,Medicare,Contracts Employment Type : Full-Time Experience: years Vacancy: 1