Reimbursement and Prior Authorization Specialist
13 hours ago
We are seeking a highly skilled Reimbursement and Prior Authorization Specialist to join our team at Guardant Health. As a key member of our team, you will play a critical role in ensuring timely and accurate reimbursement for our patients.
Key Responsibilities- Drive payment by contacting insurance companies to secure preauthorization required for patients to receive our services.
- Ensure information obtained is complete and accurate, follow up on requests, and apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements and online eligibility/preauthorization systems.
- Facilitate optimized billing processes and operations that are aligned with Guardant Health's mission and values.
- Develop and maintain a database of payer authorization requirements, and manage documentation for appropriate payer communication, correspondence, and insurance claim research.
- Track, report, and address complex outstanding claims, troubleshoot EOBs, appeal non-covered and inappropriately adjudicated claims, follow-up on claims, and drive positive coverage determinations through external appeals.
- Three years of work experience in a healthcare environment focused on healthcare reimbursement, including knowledge of health plan regulations and processes.
- Strong attention to detail, analytical skills, and ability to communicate effectively through complex scenarios.
- Experience working with a broad range of payers, coordinating with insurance providers, physicians, and patients to obtain prior authorizations, and appealing to state level agencies or external level review with IRO/IRBs.
- Proficiency in Excel, including sorting, filtering, and performing simple calculations.
Guardant Health offers a competitive hourly range of $17.50 to $27.31, a hybrid work model with defined days for in-person/onsite collaboration and work-from-home days, and a dynamic, fast-paced work environment.
As a Reimbursement and Prior Authorization Specialist at Guardant Health, you will have the opportunity to work with a talented team, drive payment and reimbursement, and contribute to the overall success of the company.
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