Reimbursement Specialist - Prior Authorization (9:00 AM - 5:30 PM CST, Monday - Friday Shift)

Company Description

Guardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary tests, vast data sets and advanced analytics. The Guardant Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum. Guardant Health has commercially launched Guardant360®, Guardant360 CDx, Guardant360 TissueNext™, Guardant360 Response™, and GuardantOMNI® tests for advanced stage cancer patients, and Guardant Reveal™ for early-stage cancer patients. The Guardant Health screening portfolio, including the Shield™ test, aims to address the needs of individuals eligible for cancer screening.

Job Description

Location: Remote, 3-Days Hybrid, and 5-Days Onsite Options 

Shift: 9:00 AM - 5:30 PM CST, Monday - Friday Shift

As a Reimbursement and Prior Authorization Specialist located in Spring, Texas you play an important role in the overall success of the company. Working with our billing tool provider, and partnering with colleagues in Finance and Client Services, you will drive payment by contacting insurance companies to secure preauthorization required for patients to receive our services. You will 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. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.

You will help develop and maintain a database of payer authorization requirements, and manage documentation for appropriate payer communication, correspondence, and insurance claim research. You’re responsible for tracking, reporting and addressing complex outstanding claims. You will work to troubleshoot EOBs, appeal non-covered and inappropriately adjudicated claims, follow-up on claims, and drive positive coverage determinations through external appeals.

Qualifications

You are interested in being on the ground floor of a dynamic, fast-paced organization. You are organized, have strong attention to detail, and are a self-starter who can work with minimal supervision. Tech-savvy and analytical, you enjoy unpacking and resolving complex issues. Customer service is in your DNA, and you are known for your ability to communicate effectively through even the most tangled scenarios.

Your background includes three years of work experience in a healthcare environment focused on healthcare reimbursement, including knowledge of health plan regulations and processes.  Your previous experience in similar roles enables you to hit the ground running and contribute insights and solutions to your team.

You should have moderate Excel skills, like the ability to sort, filter and perform simple calculations. You have experience working with a broad range of payers and have experience coordinating with insurance providers, physicians, and patients to obtain prior authorizations.  You have also appealed to state level agencies or external level review with IRO/IRBs.

Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus.

You are interested in being on the ground floor of a dynamic, fast-paced organization. You are organized, have strong attention to detail, and are a self-starter who can work with minimal supervision. Tech-savvy and analytical, you enjoy unpacking and resolving complex issues. Customer service is in your DNA, and you are known for your ability to communicate effectively through even the most tangled scenarios.

Your background includes three years of work experience in a healthcare environment focused on healthcare reimbursement, including knowledge of health plan regulations and processes.  Your previous experience in similar roles enables you to hit the ground running and contribute insights and solutions to your team.

You should have moderate Excel skills, like the ability to sort, filter and perform simple calculations. You have experience working with a broad range of payers and have experience coordinating with insurance providers, physicians, and patients to obtain prior authorizations.  You have also appealed to state level agencies or external level review with IRO/IRBs.

Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus.

Additional Information

Hybrid Work Model: At Guardant Health, we have defined days for in-person/onsite collaboration and work-from-home days for individual-focused ti