Remote Reimbursement Specialist, Prior Authorization

Summary

Join Guardant Health as a Reimbursement and Prior Authorization Specialist in Spring, Texas. You will drive payment by contacting insurance companies to secure preauthorization required for patients to receive our services.

Requirements

• Three years of work experience in a healthcare environment focused on healthcare reimbursement
• 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 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

• Drive payment by contacting 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

Benefits

Hybrid Work Model: defined days for in-person/onsite collaboration and work-from-home days for individual-focused time