Reimbursement Specialist, Follow Up and Appeals (HYBRID or REMOTE)
Company: Guardant Health
Posted on: June 25, 2022
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. These tests
fuel development of its screening program, which aims to address
the needs of asymptomatic individuals eligible for cancer
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.
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.
Covid Vaccination Policy: Starting January 7, 2022, Guardant Health
will require all employees to be fully vaccinated to either (a)
establish that they have been fully vaccinated against COVID-19; or
(b) request and obtain an approved exemption from Guardant's
COVID-19 U.S. Vaccination Policy as a reasonable accommodation, as
consistent with applicable laws. An employee is considered fully
vaccinated against COVID-19 two weeks after receiving the second
dose of a two-dose vaccine or one dose of a single-dose
vaccination. Acceptable vaccines are approved or under emergency
use authorization by the U.S. Food and Drug Administration (FDA)
and/or the World Health Organization (WHO). In addition,
fully-vaccinated employees will be required to maintain their
fully-vaccinated status under this policy by obtaining, if
applicable, any FDA-approved boosters.
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 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
To learn more about the information collected when you apply for a
position at Guardant Health, Inc. and how it is used, please review
our Privacy Notice for Job Applicants.
Please visit our career page at:
Keywords: Guardant Health, Boston , Reimbursement Specialist, Follow Up and Appeals (HYBRID or REMOTE), Other , Boston, Massachusetts
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