Clinical Payer Policy Analyst

About the Role:

The Clinical Payer Policy Analyst plays a critical role in supporting our precision medicine offerings through policy development payer engagement and reimbursement strategy. You will analyze payer policies interpret complex medical records and collaborate with cross-functional teams to shape reimbursement pathways for next-generation sequencing (NGS) assays. Your insights will help refine appeals address insurance denials and influence payer policies to ensure patients have access to vital diagnostics.

Essential Duties and Responsibilities:

• Review and interpret complex clinical records related to payer policies including Medicare and Medicaid
• Analyze coverage data to inform strategic objectives and support payer negotiations
• Collaborate with appeals teams to evaluate outcomes craft compelling rebuttals and update appeal documentation as needed
• Work cross-functionally with teams outside reimbursement including clinical regulatory and client services to ensure alignment
• Provide training and ongoing support to appeals teams on clinical and policy matters
• Assist the Senior Manager with external appeals liaising with IROs and regulatory agencies
• Review denial letters document rationale and gather relevant literature for addressing deficiencies in reviews
• Support clinical teams in prior authorization patient access and client services by providing medical expertise
• Conduct evidence searches leveraging internal resources and external experts to support coverage decisions
• Stay informed on regulatory developments and policy changes impacting specialty testing and NGS reimbursement
• Perform additional duties to support team goals and company initiatives

Qualifications :

• 2 years of experience in healthcare reimbursement clinical review or claims management
• Experience working with a variety of payers including appeals to state agencies and external review organizations
• Strong understanding of billing reimbursement and regulatory processes
• Proficiency with clinical documentation appeal writing and denials management
• Educational background: MS CGC MSN RN license or relevant degrees preferred
• Familiarity with laboratory billing systems payer portals and regional/national payers a plus
• Strong analytical problem-solving and communication skills
• Tech-savvy with Excel and data analysis tools
• Organized proactive and able to manage multiple priorities

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 base salary range for this full-time position is $65030 to $89420. 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 full-time position is $76500 to $105200. 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 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.

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