Senior Reimbursement Specialist - Prior Authorization

Company Description

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.

Job Description

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.

Qualifications

Minimum 5 + years recent experience in both professional