Guardant Health
Reimbursement Specialist, Prior Authorization
Guardant Health, Spring, Texas, us, 77391
Reimbursement Specialist, Prior Authorization
Full-timeGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through the use of its proprietary tests, vast data sets, and advanced analytics. The Guardant Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes, and lower healthcare costs across all stages of the cancer care continuum.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.Your responsibilities include:Developing and maintaining a database of payer authorization requirements.Managing documentation for appropriate payer communication, correspondence, and insurance claim research.Tracking, reporting, and addressing complex outstanding claims.Troubleshooting EOBs, appealing non-covered and inappropriately adjudicated claims, and following up on claims.Driving positive coverage determinations through external appeals.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. You should have moderate Excel skills, like the ability to sort, filter, and perform simple calculations. Experience working with a broad range of payers and coordinating with insurance providers, physicians, and patients to obtain prior authorizations is essential.Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals, and national as well as regional payers throughout the country are a plus.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.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. Individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training.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 Peopleteam@guardanthealth.com.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.
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Full-timeGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through the use of its proprietary tests, vast data sets, and advanced analytics. The Guardant Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes, and lower healthcare costs across all stages of the cancer care continuum.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.Your responsibilities include:Developing and maintaining a database of payer authorization requirements.Managing documentation for appropriate payer communication, correspondence, and insurance claim research.Tracking, reporting, and addressing complex outstanding claims.Troubleshooting EOBs, appealing non-covered and inappropriately adjudicated claims, and following up on claims.Driving positive coverage determinations through external appeals.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. You should have moderate Excel skills, like the ability to sort, filter, and perform simple calculations. Experience working with a broad range of payers and coordinating with insurance providers, physicians, and patients to obtain prior authorizations is essential.Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals, and national as well as regional payers throughout the country are a plus.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.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. Individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training.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 Peopleteam@guardanthealth.com.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.
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