Senior Reimbursement Specialist

Summary

Join Guardant Health as a Senior Reimbursement Specialist and play a vital role in the company's financial success. You will independently manage the prior authorization lifecycle, optimize billing operations, and resolve complex reimbursement issues. This position requires collaboration with internal and external teams, including ordering physician offices and offshore teams. You will maintain accurate documentation, develop training programs, and ensure compliance with HIPAA guidelines. The role offers a hybrid work model and a competitive salary.

Requirements

• Minimum 5 + years recent experience in both professional and facility coding, billing, and prior authorization with high volume and/or multiple accounts
• Experience with contacting and follow up with insurance carriers on denials, file reconsideration requests, formal appeals and negotiations
• Must be proficient using a computer, data entry, and have above average typing skills
• Intermediate to advanced MS Office including Excel
• High school diploma or equivalent, bachelor’s degree or equivalent work experience preferred

Responsibilities

• Manage Prior Authorization Lifecycle: Independently handle the full prior authorization process, ensuring timely approvals while navigating complex payer policies
• Optimize Billing Operations: Collaborate with the billing tool provider and internal teams to enhance billing efficiency in alignment with company goals
• Resolve Reimbursement Issues: Spearhead efforts to address and troubleshoot complex denials, escalations, and reimbursement challenges
• Facilitate Communication: Work closely with ordering physician offices and internal teams to ensure seamless communication and efficient claim resolution
• Maintain Accurate Documentation: Manage payer communications, correspondence, and insurance claims research while ensuring proper documentation
• Develop Training & Quality Control: Contribute to the design and implementation of training and quality assurance programs to enhance team performance
• Collaborate with Offshore Teams: Work with Reimbursement management and offshore teams handling prior authorization cases to streamline operations
• Accurately enter and maintain data in computer systems, ensuring precise account notation
• Verify and communicate insurance eligibility, billing and prior authorization details, collections, and payment responsibilities to appropriate parties
• Draft and submit written appeals with a proven track record of success
• Interpret Prior Authorization Denials, Explanation of Benefits (EOBs) and correspondence accurately for follow-up actions or appeals
• Adhere to HIPAA guidelines when providing medical records to primary care providers, insurance carriers, referred providers, and patients
• Work effectively both independently and as part of a team to achieve set goals
• Perform other related duties as assigned

Preferred Qualifications

• Experience working with a broad range of payers and have appealed to state level agencies or external level review with IRO/IRBs are a plus
• Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus

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