Reimbursement Specialist II, Follow-Up, and Appeals

Company Description

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, Follow-Up and Appeals, you will be a vital contributor within the revenue cycle team, driving impact through deep knowledge of insurance processes, payer policy, and driving payment for our services. Collaborating closely with our billing technology provider, you play a key role in partnering with colleagues in Finance and Client Services while maximizing reimbursement outcomes for the organization. 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.

With your extensive background in healthcare billing and payer engagement, strong attention to detail is critical. Strong communication and troubleshooting skills are required to support process improvement initiatives that increase efficiency and effectiveness across the department.

Key Responsibilities:

• Revenue Cycle Management:
  • Quickly analyze and interpret details from EOB/ERA files to identify reasons for claim denials or low payments in a timely manner. (Not limited to identifying errors)
  • Prepare and submit appeals for non-covered services, low payments, or disputed claims, aiming to secure positive coverage determinations through external appeals
  • Efficiently escalating complex payment issues as needed to ensure timely resolution
  • Maintain detailed documentation of payer communications, claim statuses, and research activities
  • Provide reimbursement assistance to patients while providing superior customer service and respect to patients and their families
  • Effectively verify and communicate to patients and their families insurance eligibility, billing, collections and payment responsibilities
  • Accurate data entry of information into computer systems including notating accounts accurately
  • Manage incoming correspondence from various channels (fax, email, portal) and associate them with the relevant patient/insurance records.
    • Communicating effectively via email, fax, and other channels with payers and internal stakeholders
  • Excellent oral and written communication skills for effective collaboration and reporting
    • Handling outbound and inbound calls to follow up on payment statuses and resolve issues
    • Respond to emails efficiently and effectively within the department.
    • Experience in identifying and reporting trends by Payer
    • Strong attention to detail and accuracy in data input and recordkeeping
    • Proficiency in utilizing spreadsheets for data analysis and reporting
  • Performs other added responsibilities as assigned to support the overall efficiency of the department.
    • Participate in ongoing training and education programs for software and systems used in the role.
    • Demonstrating strong time management skills to meet deadlines and ensure payment processing efficiency
    • Maintaining a high level of accuracy and attention to detail in all reimbursement and cash application tasks
  • All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company.
  • Maintain the strictest confidentiality; adhere to all HIPAA guidelines/regulations.

• Cross-functional Collaboration:
  • Communicate effectively with cross-functional teams to identify and address inefficiencies impacting ASP and claims adjudication processes.
  • Work closely with staff to investigate and resolve credit balances, missing payments, payment allocations or discrepancies related to claims/appeals.

Travel Requirements:

This role may require some travel that may include, but is not limited to:

• Participating in corporate events and quarterly/biannually/annually meetings to connect and share innovative strategies.
• Engaging in development opportunities and conferences that will enhance your skills and knowledge, empowering you to lead initiates effectively.
• Initiating and participating in teambuilding activities in person and collaborating with cross-functional teams to foster a strong, united workplace culture.

Qualifications

• Minimum of 3-5 years recent experience in both professional and facility health care claims posting, including knowledge of health plan regulations and processes with high volume and/or multiple accounts.
• Experience with contacting and follow up with insurance carriers; national as well as regional payers throughout the country.
• 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.
• Must have strong mathematical skills to accurately interpret payment & adjustment transactions (must be able to read & understand an EOB).
• Proficiency with revenue cycle tools, experience with laboratory reimbursement workflows, EDI enrollment, Payer Portal setup & management, Telcor, Waystar Clearinghouse, and Sarbanes Oxley controls (SOX) are requirements is highly desirable.
• Proven track record of working cross-functionally with internal teams and external stakeholders to resolve reimbursement challenges.
• Exceptional attention to detail, self-motivated, organizational abilities and driven to identify process improvements that enhance operational performance.
• Demonstrated proficiency with using computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel, and have above average typing skills
• Analytical mindset with experience in data analysis and process optimization.
• Ability to work independently and handle confidential and sensitive information with utmost discretion.
• Must be able to work cohesively in a team-oriented environment and be able to foster good working relationships with others both within and outside the organization
• Excellent communication and interpersonal skills to facilitate collaboration across department, with an ability to distill complex issues for both technical and non-technical audiences.

This role offers a challenging yet rewarding opportunity for a dynamic leader ready to drive sustainable improvements in a high-impact area of revenue cycle management.

AI & Digital Fluency

• Demonstrate curiosity, sound judgment, and the ability to critically evaluate and responsibly leverage AI-enabled tools in accordance with company policies, ethical standards, and regulatory requirements to improve the efficiency, effectiveness, and quality of work.

Hybrid Work Model:This section is applicable to onsite employees who are eligible for hybrid work location as specified by management and related policies. Guardant has 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 annualized base salary ranges for the primary location and any additional locations are listed below. This range does not include benefits or, if applicable, bonus, commission, or equity. Each candidate’s compensation offer will be based on multiple factors including, but not limited to, geography, experience, education, job-related skills, job duties, and business need.Primary Location: Remote - Open Position (USA)Primary Location Base Pay Range: $23 - $31Other US Location(s) Base Pay Range: $23 - $31If the role is performed in Colorado, the pay range for this job is: $24 - $33

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

A background screening including criminal history is required for this role. GH will consider qualified applicants with criminal arrest or conviction histories in a manner consistent with applicable law including but not limited to the LA County Fair Chance Policies and the Fair Chance Act (Gov. Code Section 12952).

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.

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Originally posted on Himalayas