Reimbursement Specialist II

Title: Reimbursement Specialist II

Location: Remote-USA-TX

 

Full time

Job Description:

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. 

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.
• Prior Authorization experience.
• 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.
• 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.

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 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 annualized base salary ranges for the primary location and any additional locations are listed below. This range does not include benefits or, if applicable, bonus, commission, or equity. Each candidate’s compensation offer will be based on multiple factors including, but not limited to, geography, experience, education, job-related skills, job duties, and business need. Primary Location: Remote-USA-TX Primary Location Base Pay Range: $20 - $27 Other US Location(s) Base Pay Range: $20 - $27 If the role is performed in Colorado, the pay range for this job is: $21 - $29
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.