Reimbursement Specialist II

Summary

Join Guardant Health as a Reimbursement Specialist II – Prior Authorization and become a key player in ensuring timely patient access to care and maximizing reimbursement. Based in Spring, Texas with remote, hybrid, and onsite options, you will independently manage the prior authorization lifecycle, navigating complex payer policies and resolving escalated issues. Leveraging your expertise in healthcare billing and payer engagement, you will streamline processes, troubleshoot denials, and collaborate with internal and external stakeholders. You will contribute to training programs and process improvement initiatives, working cross-functionally to ensure a high-functioning billing operation. This role requires extensive experience in healthcare reimbursement, prior authorization, and payer relations, along with proficiency in various revenue cycle tools and systems. The position offers a hybrid work model and competitive compensation.

Requirements

• Minimum of 5+ years of healthcare reimbursement experience, with a strong focus on prior authorization, insurance coordination, and payer relations
• Expert-level knowledge of Medicare, Medicaid, and commercial payer authorization policies and appeals processes
• Demonstrated success in managing complex, high-priority claims, including overturning denials through advanced appeal strategies and external reviews
• Proficiency with revenue cycle tools and systems such as Xifin, payer portals, EDI enrollment, and merchant/payment solutions
• Advanced Excel capabilities, including use of pivot tables, conditional logic, and trend analysis for reporting and decision-making
• Proven track record of working cross-functionally with internal teams and external stakeholders to resolve reimbursement challenges
• Strong written and verbal communication skills, with an ability to distill complex issues for both technical and non-technical audiences
• Detail-oriented, self-motivated, and driven to identify process improvements that enhance operational performance

Responsibilities

• Independently manage the full prior authorization lifecycle—navigating complex payer policies, securing timely approvals, and resolving escalated reimbursement issues
• Lead efforts to streamline processes, troubleshoot complex denials, and collaborate with team members and ordering physician offices to ensure seamless communication
• Manage documentation for appropriate payer communication, handling correspondence, and conducting insurance claim research
• Contribute to the development and implementation of training programs
• Champion best practices and contribute to a high-functioning, compliant billing operation
• Build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department

Preferred Qualifications

Experience with laboratory billing workflows and national/regional payer requirements is highly desirable

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