Reimbursement Specialist II
About The Position
Guardant Health is a leading precision oncology company focused on guarding wellness and giving every person more time free from cancer. Founded in 2012, Guardant is transforming patient care and accelerating new cancer therapies by providing critical insights into what drives disease through its advanced blood and tissue tests, real-world data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in early-stage cancer, and treatment selection for patients with advanced cancer. For more information, visit guardanthealth.com and follow the company on LinkedIn, X (Twitter) and Facebook. As a Reimbursement Specialist II, you play an important role in the overall success of the company. Working with our billing tool provider, you will drive payment for our services, and by partnering with colleagues in Finance and Client Services. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values. You’re responsible for tracking, reporting and addressing complex outstanding claims. You will work to troubleshoot EOBs, appeal non-covered & low pay claims, follow-up on claims, and drive positive coverage determinations through external appeals. You will manage documentation for appropriate payer communication, correspondence, and insurance claim research.
Requirements
- Minimum 3 – 5 years recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts.
- Prior Authorization experience.
- 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.
- Basic math skills to accurately interpret payment & adjustment transactions (must be able to read & understand an EOB).
- Must be proficient using a computer, data entry, and have above average typing skills.
- Intermediate to advanced MS Office including Excel.
- High school diploma or equivalent.
Nice To Haves
- Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus.
Responsibilities
- Accurate data entry of information into computer systems including notating accounts accurately
- Provide reimbursement assistance to patients while providing superior customer service and respect to patients and their families
- Resolves most patient concerns or complaints without escalation
- Effectively verify and communicate to patients and their family’s insurance eligibility, billing, collections and payment responsibilities
- Proves track record of written appeals with success
- Correctly interpret EOB’s for follow-up and/or appeals
- Follow appropriate HIPAA guidelines provide medical records to primary care provider, insurance carriers, referred providers and patients per patient request
- Work well individually and in a team environment accomplishing set goals
- Performs other related duties as assigned
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
