Reimbursement Specialist

Summary

Join Guardant Health as a Reimbursement Specialist, Follow Up and Appeals and play a vital role in ensuring timely payments for services. You will collaborate with colleagues in Finance and Client Services to optimize billing processes. Key responsibilities include tracking and resolving complex outstanding claims, appealing non-covered claims, and managing payer communication. This position requires three years of healthcare reimbursement experience, knowledge of health plan regulations, and moderate Excel skills. The role offers a hybrid work model with a blend of in-office and remote work, allowing for work-life balance.

Requirements

• Three years of work experience in a healthcare environment focused on healthcare reimbursement
• Knowledge of health plan regulations and processes
• Moderate Excel skills (sorting, filtering, simple calculations)
• Experience working with a broad range of payers
• Experience appealing to state level agencies or external level review with IRO/IRBs

Responsibilities

• Track, report and address complex outstanding claims
• Troubleshoot EOBs
• Appeal non-covered & low pay claims
• Follow-up on claims
• Drive positive coverage determinations through external appeals
• Manage documentation for appropriate payer communication, correspondence, and insurance claim research

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: A blend of in-person/onsite collaboration and work-from-home days