Reimbursement Specialist, Prior Authorization
Reimbursement Specialist, Prior Authorization
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1 Vacancy
Job Description
About the Role:
As a Reimbursement and Prior Authorization Specialist you are vital to our success. You will collaborate across teams to secure insurance preauthorizations streamline billing operations and ensure accurate and complete documentation supporting our mission to advance cancer care.
Essential Duties and Responsibilities:
Act as a primary contact for insurance companies to obtain necessary preauthorizations for patient services.
Collaborate with billing systems finance and client services teams to facilitate timely payment processing.
Maintain and update a comprehensive database of payer authorization requirements.
Manage all documentation related to payer communication correspondence and insurance claims research.
Track report and resolve complex claims ensuring prompt follow-up and resolution.
Troubleshoot Explanation of Benefits (EOBs) identify claim issues and escalate as needed.
Appeal non-covered or incorrectly adjudicated claims through external review processes.
Drive positive coverage decisions via appeals and external review organizations.
Ensure compliance with Medicare Medicaid and other third-party payer requirements and online eligibility/preauthorization systems.
Support continuous improvement of billing and authorization processes aligning with company values.
Qualifications :
0-2 years of experience in the healthcare industry.
Strong understanding of health plan regulations billing processes and third-party payer requirements.
Excellent organizational skills with high attention to detail and accuracy.
Self-motivated with the ability to work independently in a fast-paced environment.
Tech-savvy with proficiency in Excel (sorting filtering basic calculations).
Preferred Qualifications:
Experience with insurance and payer relations.
Experience working with a diverse range of payers insurance portals and prior authorization processes.
Proven ability to coordinate with insurance providers physicians and patients.
Knowledge of laboratory billing Xifin EDI enrollment and merchant solutions is a plus.
Experience with appeals at state and external review organizations (IROs/IRBs) is a plus
Additional Information :
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 hourly range for this full-time position is $20.53 to $28.24. 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
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: Work :
Yes
Employment Type :
Full-time
Employment Type
Remote
