Reimbursement Specialist II

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. 

Position Summary:

As a Reimbursement Specialist II, 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 family’s 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

Qualifications:

• Minimum 3 – 5 years recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts
• Experience with contacting and follow up with insurance carriers on denials, file 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.
• Experience working with Medicare and Medicaid.
• Basic math skills to accurately interpret payment & adjustment transactions (must be able to read & understand an EOB)
• Must be proficient using a computer, 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 are 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. 

Delegated Duties and Responsibilities:

•  

   N/A 

Approvals:

•  This job description is used as a guideline for major duties. The company reserves the right to change or assign additional duties as needed.

AI & Digital Fluency

• Demonstrate curiosity, sound judgment, and the ability to critically evaluate and responsibly leverage AI-enabled tools in accordance with company policies, ethical standards, and regulatory requirements to improve the efficiency, effectiveness, and quality of work.

Hybrid Work Model:This section is applicable to onsite employees who are eligible for hybrid work location as specified by management and related policies.  Guardant has 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 willbe 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. 

Employee may be required to lift routine office supplies and use officeequipment. 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 laboratoryenvironment. 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

A background screening including criminal history is required for this role. GH will consider qualified applicants with criminal arrest or conviction histories in a manner consistent with applicable law including but not limited to the LA County Fair Chance Policies and the Fair Chance Act (Gov. Code Section 12952).

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.

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: http://www.guardanthealth.com/jobs/