Medical Reviewer – Laboratory Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Assess laboratory-related claims, Treatment Authorization Requests (TARs), orders, and accompanying documentation.

• Analyze laboratory services in accordance with relevant medical policies, coverage criteria, and program protocols.

• Utilize laboratory expertise to determine the appropriateness of requested or billed laboratory services.

• Assist in claim adjudication and medical review processes pertaining to laboratory testing.

• Ensure documentation is thorough and compliant with program specifications.

• Accurately and promptly document review outcomes, decisions, and the rationale behind them.

• Identify issues related to documentation, billing, or coverage that necessitate further review or clarification.

• Collaborate with clinical, operational, provider-facing, and Medical Review Services teams.

• Maintain up-to-date knowledge of laboratory practices, medical policies, coverage criteria, and healthcare program guidelines.

• Achieve established standards for quality, accuracy, productivity, and turnaround times.

• Navigate various computer systems and applications to conduct reviews and document findings.

• Facilitate timely decisions for California healthcare programs.

⛳️ Requirements

• A minimum of two (2) years of experience working as a laboratory technician.

• High school diploma or equivalent qualification.

• Completion of a Medical Laboratory Technician program from an accredited institution.

• Familiarity with laboratory procedures, terminology, testing methods, and documentation practices.

• Capability to interpret laboratory-related records, orders, claims, and supporting documentation.

• Strong analytical, written, and verbal communication skills.

• Ability to work autonomously while effectively collaborating with clinical, operational, and cross-functional teams.

• Maintain all necessary professional certifications and credentials for the role in active and good standing, as applicable.

🏝️ Benefits

• Flexible working hours.

• Work-life balance.

• Opportunities for continuous learning and career advancement.

• Remote work flexibility.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development programs.

• Ongoing training and support.

• 0–10% travel requirement.