Reimbursement Specialist II - Prior Authorization - Screening

Summary

Join Guardant Health's Reimbursement Operations team as a Reimbursement Specialist II – Prior Authorization. This role focuses on managing the prior authorization lifecycle, ensuring timely patient access to care and maximizing reimbursement. You will navigate complex payer policies, resolve escalated issues, and streamline processes. Collaboration with cross-functional teams is key, requiring effective communication and problem-solving skills. The position demands expertise in healthcare billing, payer engagement, and prior authorization strategies. This role offers a hybrid work model with options for remote, 3-day hybrid, or 5-day onsite work.

Requirements

• Minimum of 3+ years of healthcare reimbursement experience, with a strong focus on prior authorization, insurance coordination, payer relations and appeals
• Expert-level knowledge of Medicare, Medicaid, IPA 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/Telcor, payer portals, and Salesforce
• Proven track record of working cross-functionally with internal teams and external stakeholders to resolve reimbursement challenges
• Exceptional attention to detail, self-motivated, organizational abilities and driven to identify process improvements that enhance operational performance
• Demonstrated proficiency with using a computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel, and have above average typing skills
• Experience with contacting and follow up with insurance carriers
• Analytical mindset with experience in data analysis and process optimization
• Ability to work independently and handle confidential and sensitive information with utmost discretion
• Must be able to work cohesively in a team-oriented environment and be able to foster good working relationships with others both within and outside the organization
• Excellent communication and interpersonal skills to facilitate collaboration across department, with an ability to distill complex issues for both technical and non-technical audiences

Responsibilities

• Manage the full prior authorization lifecycle, including navigating complex payer policies and securing timely approvals
• Actively review, submit, track and resolve Prior Authorization inquiries using appropriate systems and tools (SalesForce/Telcor/Emails/Fax/Phone/Portals) until final approval is obtained
• Resolve escalated rejected authorizations issues and streamline processes for efficiency
• Research system notes to obtain missing or corrected insurance or demographic information
• Prepare and submit necessary medical records, documentation, and justification to insurance companies
• Ensure all required documentation is complete and accurate to avoid delays in authorization
• Manage faxes, emails, phone calls and respond to voicemails and emails
• Maintain comprehensive documentation of payer requirements and support process improvement initiatives
• Follow appropriate HIPAA guidelines
• Performs other added responsibilities as assigned to support the overall efficiency of the department
• All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company
• Communicate effectively with cross-functional teams and ordering physician offices to identify and address inefficiencies impacting ASP and claims adjudication processes
• Work closely with staff to investigate and resolve delays, rejections, or discrepancies related to claims submissions for optimal reimbursement
• Participating in corporate events and quarterly/biannually/annually meetings to connect and share innovative strategies
• Engaging in development opportunities and conferences that will enhance your skills and knowledge, empowering you to lead initiates effectively
• Initiating and participating in teambuilding activities in person and collaborating with cross-functional teams to foster a strong, united workplace culture

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