Reimbursement Specialist - Follow Up & Appeals

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.

(This position is Full-Time; will consider Full-Time Remote, 3-Days Hybrid, and 5-Days Onsite Options)

As a Reimbursement Specialist – Follow Up and Appeals, 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’re responsible for tracking, reporting and addressing complex outstanding claims. You will work to troubleshoot EOBs, appeal non-covered & low pay claims, follow-up on claims, and drive positive coverage determinations through external appeals. You will manage documentation for appropriate payer communication, correspondence, and insurance claim research.

Essential Duties and Responsibilities:

• Accurate data entry of information into computer systems including notating accounts accurately
• Provide reimbursement assistance to patients while providing superior customer service and respect to patients and their families
• Resolves most patient concerns or complaints without escalation
• Effectively verify and communicate to patients and their families insurance eligibility, billing, collections and payment responsibilities
• Proves track record of written appeals with success
• Correctly interpret EOB’s for follow-up and/or appeals
• Follow appropriate HIPAA guidelines provide medical records to primary care provider, insurance carriers, referred providers and patients per patient request
• Work well individually and in a team environment accomplishing set goals
• Performs other related duties as assigned

• A minimum 3 years of recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts
• Experience with contacting and following up with insurance carriers on denials, filing 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.
• Basic math skills to accurately interpret payment & adjustment transactions (must be able to read & understand an EOB)
• Must be proficient using a computer, and 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 is a plus
• High school diploma or equivalent

Work Environment:

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.

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 base salary range for this full-time position is <> to <>. The range does not include benefits, and if applicable, 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).

The US hourly range for this full-time position is $25 to $37.50. 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 Peopleteam@guardanthealth.com

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/

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