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Reimbursement Specialist, Prior Authorization

4 months ago

Spring, United States Guardant Health Full time
Job Description

As a Reimbursement and Prior Authorization Specialist located in Spring, Texas you play an important role in the overall success of the company. Working with our billing tool provider, and partnering with colleagues in Finance and Client Services, you will drive payment by contacting insurance companies to secure preauthorization required for patients to receive our services. You will 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. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.

You will help develop and maintain a database of payer authorization requirements, and manage documentation for appropriate payer communication, correspondence, and insurance claim research. You’re responsible for tracking, reporting and addressing complex outstanding claims. You will work to troubleshoot EOBs, appeal non-covered and inappropriately adjudicated claims, follow-up on claims, and drive positive coverage determinations through external appeals.

Qualifications

You are interested in being on the ground floor of a dynamic, fast-paced organization. You are organized, have strong attention to detail, and are a self-starter who can work with minimal supervision. Tech-savvy and analytical, you enjoy unpacking and resolving complex issues. Customer service is in your DNA, and you are known for your ability to communicate effectively through even the most tangled scenarios.

Your background includes three years of work experience in a healthcare environment focused on healthcare reimbursement, including knowledge of health plan regulations and processes. Your previous experience in similar roles enables you to hit the ground running and contribute insights and solutions to your team.

You should have moderate Excel skills, like the ability to sort, filter and perform simple calculations. You have experience working with a broad range of payers and have experience coordinating with insurance providers, physicians, and patients to obtain prior authorizations. You have also appealed to state level agencies or external level review with IRO/IRBs.

Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are 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$17.50 to $27.31. 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.