Sr. Billing Compliance Analyst

Guardant Health

4d•Hybrid

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. Are you passionate about compliance and accuracy in healthcare? As a Billing Compliance Auditor, you’ll play a critical role in safeguarding ethical billing practices for cutting-edge molecular diagnostics. This position offers the opportunity to combine your expertise in regulations and coding with a commitment to patient-centered care helping us maintain trust, transparency, and excellence in every claim we submit. The Billing Compliance Auditor is responsible for ensuring accurate, ethical, and regulation-aligned billing practices for the laboratory’s oncology diagnostic testing services. This role conducts retrospective and prospective audits, evaluates billing operations for adherence to federal and state regulations, payer policies, and internal SOPs, and partners with internal teams to mitigate risk, strengthen documentation, and support clean claim submission. The auditor plays a key role in maintaining the integrity of the laboratory’s revenue cycle and safeguarding compliance in a highly regulated molecular diagnostics environment.

Requirements

Bachelor’s degree in Healthcare Administration, Medical Billing, Health Information Management, or related field; or equivalent experience
5+ years of experience in medical billing, revenue cycle, or compliance auditing preferably in a molecular diagnostics or pathology environment
Knowledge of CPT, HCPCS, ICD-10, and payer reimbursement policies for laboratory services
Experience interpreting Medicare LCDs/NCDs, particularly for molecular/NGS testing
Strong analytical, investigative, and documentation skills
Ability to work with sensitive information while maintaining confidentiality

Nice To Haves

Experience with oncology/laboratory coding, molecular pathology guidelines, and genetic testing policies
Familiarity with reimbursement systems, LIMS, EMR/EHR integrations, and clearinghouses
Understanding of OIG work plans and compliance frameworks in laboratory settings
Certification(s): CPC, CPMA, CCA, CCS, CHC, or equivalent
Attention to detail and accuracy
Critical thinking and problem-solving
Strong written and verbal communication
Ability to manage multiple concurrent audits or projects
Collaborative approach with cross-functional teams
Commitment to compliance and ethical billing practices

Responsibilities

Perform routine and targeted audits of claims, charge capture, coding, and reimbursement activities for molecular/NGS testing
Validate that CPT/HCPCS codes, modifiers, units, and diagnosis codes are accurate and supported by documentation
Monitor compliance with Medicare, Medicaid, commercial payer policies, NCCI edits, and LCD/NCD requirements specific to molecular pathology and oncology testing
Identify root causes of billing errors, patterns of non-compliance, and potential areas of financial or regulatory risk
Review laboratory reports, requisitions, clinical documentation, and test orders to ensure compliance with billing rules and medical necessity criteria
Confirm alignment of billed services with laboratory workflows, reporting practices, and test menus (e.g., single-gene assays, NGS panels, somatic variant analysis)
Maintain up-to-date knowledge of relevant regulations (CLIA, CMS, OIG guidance, HIPAA, PAMA, applicable state laws)
Provide actionable feedback and training to billing, revenue cycle, and client services regarding audit findings
Collaborate with billing leadership to revise SOPs, coding guidelines, and internal controls to prevent errors
Support readiness for internal and external audits, including payer audits, RAC audits, and accreditation reviews
Prepare detailed audit reports summarizing findings, corrective actions, and compliance risks
Track audit metrics, trends, and key performance indicators to support continuous improvement
Escalate high-risk issues to leadership and assist in developing corrective action plans