Reimbursement Specialist

Summary

Join Guardant Health as a Reimbursement and Prior Authorization Specialist and play a vital role in ensuring timely patient payments. Working remotely or in a hybrid model, you will collaborate with various teams to secure pre-authorizations from insurance companies. Your responsibilities include managing payer requirements, tracking claims, resolving issues, and appealing denials. This position requires three years of healthcare reimbursement experience, knowledge of health plan regulations, and moderate Excel skills. The ideal candidate is organized, detail-oriented, and possesses strong communication skills. Guardant Health offers a hybrid work model and competitive compensation.

Requirements

• Three years of work experience in a healthcare environment focused on healthcare reimbursement, including knowledge of health plan regulations and processes
• Moderate Excel skills, like the ability to sort, filter and perform simple calculations
• Experience working with a broad range of payers
• Experience coordinating with insurance providers, physicians, and patients to obtain prior authorizations
• Experience appealing to state level agencies or external level review with IRO/IRBs

Responsibilities

• Contact insurance companies to secure preauthorization required for patients to receive services
• Ensure information obtained is complete and accurate
• Follow up on requests
• Apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements and online eligibility/preauthorization systems
• Facilitate optimized billing processes and operations aligned with Guardant Health’s mission and values
• Develop and maintain a database of payer authorization requirements
• Manage documentation for appropriate payer communication, correspondence, and insurance claim research
• Track, report and address complex outstanding claims
• Troubleshoot EOBs
• Appeal non-covered and inappropriately adjudicated claims
• Follow-up on claims
• Drive positive coverage determinations through external appeals

Preferred Qualifications

• Familiarity with laboratory billing
• Familiarity with Xifin
• Familiarity with EDI enrollment
• Familiarity with merchant solutions
• Familiarity with payer portals
• Familiarity with national as well as regional payers throughout the country

Benefits

Hybrid Work Model: In-person/onsite collaboration and work-from-home days