Remote Medical Reviewer - Laboratory Specialist

Gainwell Technologies; West Sacramento (CA); On-site; USD 50,000 - 60,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Flexible vacation policy

Educational assistance

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 services meet coverage, medical necessity, and program requirements.

The role is full-time with a remote work environment and a Monday–Friday schedule.

Qualifications

• Two+ years of experience as a laboratory technician.
• Knowledge of laboratory procedures, terminology, testing, and documentation.
• Ability to interpret laboratory-related records, orders, claims, and supporting documentation.
• Strong analytical, written, and verbal communication skills.
• Ability to work independently while collaborating with clinical, operational, and cross-functional teams.

Responsibilities

• Review laboratory-related claims, TARs, orders, and supporting documentation.
• Evaluate laboratory services based on medical policies, coverage requirements, and program guidelines.
• Apply laboratory expertise to 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 program requirements.
• Document review findings, decisions, and rationale accurately and timely.
• Identify documentation, billing, or coverage issues requiring further review or clarification.
• Collaborate with clinical, operational, provider-facing, and other Medical Review Services teams to resolve questions.
• Maintain knowledge of applicable laboratory practices, policies, and regulatory guidelines.
• Meet quality, accuracy, productivity, and turnaround-time expectations.

Skills

Laboratory experience

Analytical skills

Written and verbal communication

Independent work

Cross-functional collaboration

Education

High school diploma or equivalent

Medical Laboratory Technician program from an accredited school

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 services meet coverage, medical necessity, and program requirements.

The role is full-time with a remote work environment and a Monday–Friday schedule.