Senior Reimbursement Specialist - Prior Authorization

Guardant Health is a leading precision oncology company focused on guarding wellness and giving every person more time free from cancer. Founded in 2012, Guardant is transforming patient care and accelerating new cancer therapies by providing critical insights into what drives disease through its advanced blood and tissue tests, real-world data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in early-stage cancer, and treatment selection for patients with advanced cancer. For more information, visit guardanthealth.com and follow the company on LinkedIn, X (Twitter) and Facebook.

As a Senior Reimbursement Specialist, you play a crucial role in driving the financial success of our organization. Collaborating with our billing tool provider and internal teams, you will optimize billing operations in alignment with Guardant Health’s mission and values.

In this role, you will independently manage the full prior authorization lifecycle, ensuring timely approvals while navigating complex payer policies. Leveraging your deep expertise in healthcare billing and payer engagement, you will spearhead efforts to streamline processes, resolve escalated reimbursement issues, and troubleshoot complex denials. You will work closely with ordering physician offices and internal teams to facilitate seamless communication and efficient prior authorization resolution.

Additionally, you will be responsible for maintaining accurate documentation for payer communications, handling correspondence, and conducting insurance claims and prior authorization research. Your expertise will contribute to the development and implementation of training and quality control programs. You will also collaborate with Reimbursement management and offshore teams handling prior authorization cases.

Key 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.

• 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
• 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.
• Must be proficient using a computer, data entry, and have above average typing skills
• Intermediate to advanced MS Office including Excel
• Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus
• High school diploma or equivalent, bachelor’s degree or equivalent work experience preferred

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. We have found aligning our scheduled in-office days allows our teams to do the best work and creates the focused thinking time our innovative work requires. At Guardant, our work model has created flexibility for better work-life balance while keeping teams connected to advance our science for our patients.

The US hourly range for this full-time position is $24.15 to $33.22. The range does not include benefits and, if applicable, overtime, bonus, commission, or equity. The range displayed reflects the minimum and maximum target for new hire salaries across all US locations for the posted role with the exception of any locations specifically referenced below (if any).

Within the range, individual pay is determined by work location and additional factors, including, but not limited to, job-related skills, experience, and relevant education or training. If you are selected to move forward, the recruiting team will provide details specific to the factors above.

Employee may be required to lift routine office supplies and use office equipment. Majority of the work is performed in a desk/office environment; however, there may be exposure to high noise levels, fumes, and biohazard material in the laboratory environment. Ability to sit for extended periods of time.

Guardant Health is committed to providing reasonable accommodations in our hiring processes for candidates with disabilities, long-term conditions, mental health conditions, or sincerely held religious beliefs. If you need support, please reach out to [email protected]

Guardant Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

All your information will be kept confidential according to EEO guidelines.

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Please visit our career page at: http://www.guardanthealth.com/jobs/