Reimbursement Specialist II
Guardant Health
Summary
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.
Job description
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 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
Qualifications
- Minimum 3 – 5 years recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts
- 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.
- Experience working with Medicare and Medicaid.
- 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
- Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus
- High school diploma or equivalent
Requirements
- Minimum 3 – 5 years recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts
- 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.
- Experience working with Medicare and Medicaid.
- 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
Company overview
Guardant Health, Inc. is a leading precision oncology company headquartered in Palo Alto, California, focused on transforming cancer care through advanced blood and tissue testing technologies. Founded in 2012 by Helmy Eltoukhy and AmirAli Talasaz, who serve as co-CEOs, the company specializes in liquid biopsy tests that detect cancer from circulating tumor DNA in blood samples. Guardant Health's flagship product, Guardant360, was the first comprehensive liquid biopsy test approved by the FDA for tumor mutation profiling and companion diagnostics in non-small cell lung cancer. The company has expanded its portfolio to include Guardant Reveal for residual disease monitoring, Guardant360 TissueNext tissue testing, and Shield, the first FDA-approved blood test for colorectal cancer screening. Guardant Health operates globally with approximately 1,999 employees and generates revenue from precision oncology testing services for clinical and biopharmaceutical customers, as well as development services and technology licensing. The company's innovative approach enables earlier cancer detection, treatment selection, and monitoring, helping to improve patient outcomes across all stages of cancer care.