Supervisor, Reimbursement - Follow Up & Appeals
Supervisor, Reimbursement - Follow Up & Appeals
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Job Description
About the Role:
As a Supervisor Reimbursement Follow Up & Appeals you play an important role in the overall success of the company and oversight to a dedicated team of Individual Contributors. This role is pivotal in driving sustainable improvements in Average Sale Price (ASP) and overall revenue cycle performance by leading mentoring and optimizing processes within the Department. The role requires a collaborative proficient in data analysis process optimization and crossfunctional coordination committed to maintaining high standards in claim adjudication and fostering a culture of continuous quality enhancement.
You will facilitate optimized billing processes and operations that are aligned with Guardant Healths mission and values. You are responsible for facilitating efficiency improvements such as: Claims and Appeal Followup EDI/ERA/EFT enrollments lockbox improvements eligibility validations and provider payer portal registration properly and timely. This includes managing daytoday activities and provides guidance to the team to ensure accurate and timely documentation for services related to the members claim and/or appeal. 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 subject matter expert and primary resource for staff and stakeholders on compliance processes regulations and issues providing guidance and clarity.
- Collaborate with Revenue Cycle Manager Leadership to proactively audit claims and collections across all thirdparty payersincluding Medicare managed care commercial insurance and patient paymentsto ensure accuracy and maximize cash flow.
- Assure maximization of cash collections through organized diligent and timely focused monitoring of all open accounts receivable balances.
- Analyze reimbursement data from various sources review carrier exception reports and follow up on pending claims and denials presenting findings to leadership and developing action plans to mitigate risks.
- Prepare comprehensive reports on billing activities accounts receivable metrics bad debt expenses and days outstanding to support continuous process improvements.
- Conduct audits of billing records to verify data accuracy and completeness including payment posting and contractual adjustments.
- Assist in developing and maintaining department Standard Operating Procedures (SOPs) aligned with CLSI guidelines ensuring staff adherence to policies and deadlines.
- Evaluate key performance indicators (KPIs) provide performance feedback and support staff development and coaching for accurate documentation and timely claim submissions.
- Facilitate onboarding training and updates to training materials workflows and change management strategies to foster an efficient compliant revenue cycle environment.
- Follow HIPAA and other regulatory guidelines diligently to protect patient information and ensure confidentiality.
- Performs other related duties as assigned to support the overall efficiency of the department
Qualifications :
- High school diploma or equivalent degree from an accredited college or university in business healthcare administration or related major (relevant experience may be considered in lieu of degree)
- A minimum of 3years of experience in both professional healthcare revenue cycle management and at least 1 year of related experience in a leadership role reflective of the level of this position
- Excellent leadership and team management skills
- Exceptional attention to detail and accuracy
- Knowledge of medical terminology CPT and ICD coding
- Knowledge in managed care requirements as they relate to reimbursement knowledge of US Commercial Medicare Medicaid and thirdparty payer reimbursement preferred
- Experience with contacting and followup with insurance carriers file reconsideration requests formal appeals and negotiations (preferred)
- Must be proficient using a computer PC software specifically Microsoft Office Suite particularly Excel and have above average typing skills
- Excellent communication skills both written and verbal
- Familiarity with laboratory billing Xifin Telcor payer portals and national as well as regional payers throughout the country is a plus
- Ability to effectively incorporate the mission and core values into processes and workflows
- Effective interpersonal skills to facilitate work in a team environment and to collaborate with a variety of professionals
Additional Information :
Hybrid Work Model: At Guardant Health we have defined days for inperson/onsite collaboration and workfromhome days for individualfocused 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 inoffice 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 worklife balance while keeping teams connected to advance our science for our patients.
The US base salary range for this fulltime position is $83220 to $114480. 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).
For positions based in Palo Alto CA or Redwood City CA the base salary range for this fulltime position is $97900 to $134650. The range does not include benefits and if applicable bonus commission or equity.
Within the range individual pay is determined by work location and additional factors including but not limited to jobrelated 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 longterm conditions mental health conditions or sincerely held religious beliefs. If you need support please reach out to
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.
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Yes
Employment Type :
Fulltime
Employment Type
Remote
