Supervisor, Reimbursement - 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. 

As a Supervisor, Reimbursement Prior Authorization, you play an important role in the overall success of the company. Working with our billing tool provider, you will drive payment for our services, and by partnering with colleagues in Finance and Client Services. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.

You are responsible for facilitating the prior authorization request process for required authorizations to ensure work queue is managed and addressed properly and timely. Manage day-to-day activities and provides guidance to the authorization team on documenting and resolving all authorization requests and/or issues to ensure accurate and timely documentation for services related to the members healthcare eligibility and access. You will be expected to be knowledgeable of, and be able to perform, the duties of the staff supervised. Strong communication and troubleshooting skills are required.

Essential Duties and Responsibilities:

• Serve as the knowledge expert and information source for staff, key stake holders,
• Ensures authorization team’s compliance with contract requirements, policies, procedures, and performance standards
• Monitors authorization requests inventory to ensure proper resources allocation throughout the day
• Maintains knowledge of contract requirements, policies, procedures, and performance standards
• Assist in the reimbursement appeals process by providing chronological documentation/tracking of prior-authorization verification and advisor follow-up for cases under review.
• Works with authorization team and senior management to identify opportunities for process and quality improvements within authorization request processes
• Evaluates authorization team performance and provides feedback regarding performance, goals, and career milestones
• Provides coaching and guidance to authorization team and department productivity goals to ensure accurate and timely documentation for services and improve processing and quality of authorization requests
• Proactively monitor for organization risks, communicates risks to leadership and develop action plans to mitigate risks
• Assists with onboarding, hiring, and training authorization team members. Participates in developing and/or updating job aids, training modules, workflows and implements change management strategies
• Manage the import and export of documents through insurance portals, ensuring timely submission of prior authorization requests, ensuring accuracy and compliance with procedures
• Follow appropriate HIPAA guidelines
• Work well individually and in a team environment accomplishing set KPI goals
• Performs other related duties as assigned to support the overall efficiency of the department

This role may require some travel that may include, but is not l