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Reimbursement Specialist - Follow Up and Appeals (ONSITE, HYBRID or REMOTE Option)

Company: Guardant Health
Location: San Diego
Posted on: November 26, 2022

Job Description:

Company Description
Guardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary blood 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. Guardant Health has launched liquid biopsy-based Guardant360 -, Guardant360 CDx and GuardantOMNI - tests for advanced stage cancer patients. These tests fuel development of its LUNAR program, which aims to address the needs of early stage cancer patients with neoadjuvant and adjuvant treatment selection, cancer survivors with surveillance, asymptomatic individuals eligible for cancer screening and individuals at a higher risk for developing cancer with early detection.
Job Description
As a Billing and Reimbursement Specialist, 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.
Essential Duties and 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 families 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
    Qualifications
    • A minimum of 1+ year of experience recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts
    • Experience with contacting and following up with insurance carriers on denials, filing reconsideration requests, formal appeals, and negotiations
    • Experience working with a broad range of payers and have appealed to state-level agencies or external level reviews with IRO/IRBs
    • Advanced 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
    • Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals, and national as well as regional payers throughout the country is a plus
    • High school diploma or equivalent
      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.
      Covid Vaccination Policy: Starting January 7, 2022, Guardant Health will require all employees to be fully vaccinated to either (a) establish that they have been fully vaccinated against COVID-19; or (b) request and obtain an approved exemption from Guardant's COVID-19 U.S. Vaccination Policy as a reasonable accommodation, as consistent with applicable laws. An employee is considered fully vaccinated against COVID-19 two weeks after receiving the second dose of a two-dose vaccine or one dose of a single-dose vaccination. Acceptable vaccines are approved or under emergency use authorization by the U.S. Food and Drug Administration (FDA) and/or the World Health Organization (WHO). In addition, fully-vaccinated employees will be required to maintain their fully-vaccinated status under this policy by obtaining, if applicable, any FDA-approved boosters.
      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.
      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.
      To learn more about the information collected when you apply for a position at Guardant Health, Inc. and how it is used, please review our Privacy Notice for Job Applicants.
      Please visit our career page at: http://www.guardanthealth.com/jobs/
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Keywords: Guardant Health, San Diego , Reimbursement Specialist - Follow Up and Appeals (ONSITE, HYBRID or REMOTE Option), Other , San Diego, California

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