Senior Reimbursement Specialist - Prior Authorization
Senior Reimbursement Specialist - Prior Authorization
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Job Description
As a Senior Reimbursement Specialist you play a crucial role in driving the financial success of our organization. Collaborating with our billing tool provider and internal teams you will optimize billing operations in alignment with Guardant Healths mission and values.
In this role you will independently manage the full prior authorization lifecycle ensuring timely approvals while navigating complex payer policies. Leveraging your deep expertise in healthcare billing and payer engagement you will spearhead efforts to streamline processes resolve escalated reimbursement issues and troubleshoot complex denials. You will work closely with ordering physician offices and internal teams to facilitate seamless communication and efficient prior authorization resolution.
Additionally you will be responsible for maintaining accurate documentation for payer communications handling correspondence and conducting insurance claims and prior authorization research. Your expertise will contribute to the development and implementation of training and quality control programs. You will also collaborate with Reimbursement management and offshore teams handling prior authorization cases.
Key Responsibilities:
- Manage Prior Authorization Lifecycle: Independently handle the full prior authorization process ensuring timely approvals while navigating complex payer policies.
- Optimize Billing Operations: Collaborate with the billing tool provider and internal teams to enhance billing efficiency in alignment with company goals.
- Resolve Reimbursement Issues: Spearhead efforts to address and troubleshoot complex denials escalations and reimbursement challenges.
- Facilitate Communication: Work closely with ordering physician offices and internal teams to ensure seamless communication and efficient claim resolution.
- Maintain Accurate Documentation: Manage payer communications correspondence and insurance claims research while ensuring proper documentation.
- Develop Training & Quality Control: Contribute to the design and implementation of training and quality assurance programs to enhance team performance.
- Collaborate with Offshore Teams: Work with Reimbursement management and offshore teams handling prior authorization cases to streamline operations
- Accurately enter and maintain data in computer systems ensuring precise account notation.
- Verify and communicate insurance eligibility billing and prior authorization details collections and payment responsibilities to appropriate parties.
- Draft and submit written appeals with a proven track record of success.
- Interpret Prior Authorization Denials Explanation of Benefits (EOBs) and correspondence accurately for follow-up actions or appeals.
- Adhere to HIPAA guidelines when providing medical records to primary care providers insurance carriers referred providers and patients.
- Work effectively both independently and as part of a team to achieve set goals.
- Perform other related duties as assigned.
Qualifications :
- Minimum 5 years recent experience in both professional and facility coding billing and prior authorization 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 are a plus.
- 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 bachelors degree or equivalent work experience preferred
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 $24.15 to $33.23. 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).
For positions based in Palo Alto CA or Redwood City CA the hourly range for this full-time position is $28.41 to $39.09. The range does not include benefits and if applicable overtime 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
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.
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Employment Type :
Full-time
Employment Type
Remote
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