Remote Medical Reviewer - Laboratory Specialist

Gainwell Technologies LLC; California; Remote; USD 50,000 - 60,000; Full time

Benefits offered by this job

Remote work

Job summary

Gainwell Technologies is seeking a Medical Reviewer (Laboratory Specialist) to provide laboratory subject-matter expertise supporting Medical Review Services for California healthcare programs. You will review laboratory-related claims, TARs, orders, and supporting documentation to ensure coverage, medical necessity, and program requirements.

You will work remotely, collaborating with physicians, nurses, and cross-functional teams to deliver timely determinations while maintaining certifications

Qualifications

• Minimum two years of laboratory technician experience.
• Completion of an Medical Laboratory Technician program from an accredited school.
• Knowledge of laboratory procedures, terminology, testing, and documentation.
• Ability to interpret laboratory-related records, orders, claims, and supporting documentation.

Responsibilities

• Review laboratory-related claims, TARs, orders, and supporting documentation.
• Evaluate laboratory services based on applicable medical policies, coverage requirements, and program guidelines.
• Apply laboratory expertise when reviewing the appropriateness of requested or billed laboratory services.
• Support claim adjudication and medical review activities involving laboratory testing.
• Review supporting documentation for completeness and alignment with applicable program requirements.
• Document review findings, decisions, and supporting rationale accurately and timely.
• Identify documentation, billing, or coverage issues requiring additional review or clarification.
• Collaborate with clinical, operational, provider-facing, and other Medical Review Services teams to resolve questions.
• Maintain knowledge of applicable laboratory practices, medical policies, coverage requirements, and healthcare program guidelines.
• Meet established quality, accuracy, productivity, and turnaround-time expectations.

Skills

Laboratory knowledge

Analytical skills

Written communication

Verbal communication

Education

High school diploma

Medical Laboratory Technician program

Job description

Gainwell Technologies is seeking a Medical Reviewer (Laboratory Specialist) to provide laboratory subject-matter expertise supporting Medical Review Services for California healthcare programs. You will review laboratory-related claims, TARs, orders, and supporting documentation to ensure coverage, medical necessity, and program requirements.

You will work remotely, collaborating with physicians, nurses, and cross-functional teams to deliver timely determinations while maintaining certifications