Reimbursement Specialist

Summary

Join Guardant Health as a Reimbursement and Prior Authorization Specialist and play a vital role in ensuring timely payments for services. Based in Spring, Texas with remote, hybrid, or onsite options, you will collaborate with insurance companies to secure pre-authorizations, maintain payer requirement databases, and manage claim documentation. You will troubleshoot claims, appeal denials, and optimize billing processes. 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 and problem-solving abilities.

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 and have 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 our services
• Ensure information obtained is complete and accurate, follow up on requests, and apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements and online eligibility/preauthorization systems
• Facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values
• Help develop and maintain a database of payer authorization requirements, and 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, and drive positive coverage determinations through external appeals

Preferred Qualifications

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

Benefits

Hybrid Work Model: At Guardant Health, we have defined days for in-person/onsite collaboration and work-from-home days for individual-focused time. All U.S. employees who live within 50 miles of a Guardant facility will be required to be onsite on Mondays, Tuesdays, and Thursdays