Medical Reviewer, Laboratory Specialist

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

📋 Description

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

• Analyze laboratory services in accordance with relevant medical policies, coverage standards, and program guidelines.

• Utilize laboratory knowledge when determining the appropriateness of requested or billed laboratory services.

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

• Evaluate documentation for thoroughness and compliance with program regulations.

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

• Identify issues in documentation, billing, or coverage that necessitate further examination or clarification.

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

• Stay informed about laboratory practices, medical policies, coverage standards, and healthcare program guidelines.

• Navigate various computer systems and applications to perform reviews and record findings.

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

• Primarily work from a home office supporting California healthcare programs.

⛳️ Requirements

• At least two (2) years of experience as a laboratory technician.

• High school diploma or equivalent qualification.

• Completion of an accredited Medical Laboratory Technician program.

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

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

• Excellent analytical, written, and verbal communication abilities.

• 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 status, as required.

🏝️ Benefits

• Flexible working hours.

• Work-life balance.

• Opportunities for continuous learning and career advancement.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Ongoing training and support.

• Remote work setting.

• 0–10% travel requirement.