Senior Director, Reimbursement (Oncology)
Guardant Health
Summary
The Senior Director of Reimbursement has in-depth expertise in developing and implementing strategic and tactical reimbursement/market access initiatives in the US. A key focus of this position is to collaborate with Guardant Health insurance companies, physicians, hospitals and government agencies. The role is also focused on supporting internal and external customers as well as key stakeholders in all aspects of the reimbursement process. The internal support will rely heavily on program management software infrastructure projects to automate processes to maximize efficiency and claim reimbursement. These skills would include eligibility automation, prior authorization automation, LIMS integration with the cloud sourced billing tool and Salesforce. The candidate should have significant knowledge in laboratory billing laws regulations and compliance activities to ensure that when interfacing with new product development they are able to provide guidance around the parameters required to successfully commercialize new tests. The candidate is highly skilled at developing relationships as well as working across the organization to achieve reimbursement and patient access goals that are aligned with sales and marketing strategies.
Job description
Essential Duties and Responsibilities
- Acts as company subject matter expert in billing and payment strategy focusing on optimizing revenue cycle management to achieve maximum reimbursement.
- Manages a team to ensure approval and correct processing of patient claims to insurance companies with high customer satisfaction.
- Oversees the design and build a Patient Financial Assistance Program
- Partners with our internal resources to develop internal metrics and optimization strategies for data and history, enabling development of simple and easily accessible data that will be used to direct our reimbursement strategy for new and existing products
- Partners with internal and external software developers to enable automated workflows and process efficiency for RCM
- Oversees the strategy and development of internal operational policies and SOPs that will scale with the organization
- Builds and sustains positive partnerships with Payers and Providers, to ensure processes are in place to ensure contracts are loaded and claims adjudication is managed in a manner consistent with contractual or regulatory language
- Collaborates with internal and external stakeholders to successfully resolve challenges with patient billing and other provider issues
- Manages and supports the operational and administrative process for billing, ensuring efficient, effective and compliant revenue cycle management
- Interfaces regularly with finance to be able to help with FP&A as well as SOX and determination of ASP for products
Qualifications
- 15+ years total experience, 5+ years professional experience in Reimbursement and Billing in a life sciences, payer setting, 5+ years management experience with a billing team
- Bachelor’s degree required; graduate degree in a related field such as public health or public policy preferred
- Open to travel up to 15%
- Experienced working with payers as a laboratory that bills molecular tests
- Experience and knowledge of federal and state legislative environments and regulatory processes to dissect complex scenarios and are able to bring issues to swift resolution
- Expert in medical billing, third party payers and patient interface, patient privacy and confidentiality paramount
- Follow payer policy activities on coverage and payment technology processes and practices
- In-depth knowledge of SOP development in a HIPAA-compliant environment and molecular billing codes and regulations
- A highly effective people manager and have experience in vendor management, with a keen focus on optimizing processes and practices in a rapidly changing environment.
- Program management and systems engineering skills are a significant plus to assist with process design
- Strong analysis skills and ability to interface a variety of software tools to quickly perform analyses to answer questions and make decisions.
- Excel skills are mandatory, SQL or other databasing skills are desirable
- AI and or PowerAutomate experience a significant plus
- 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.
Requirements
- 15+ years total experience
- 5+ years professional experience in Reimbursement and Billing in a life sciences, payer setting
- 5+ years management experience with a billing team
- Bachelor’s degree required
- Open to travel up to 15%
- Experienced working with payers as a laboratory that bills molecular tests
- Experience and knowledge of federal and state legislative environments and regulatory processes
- Expert in medical billing, third party payers and patient interface
- In-depth knowledge of SOP development in a HIPAA-compliant environment and molecular billing codes and regulations
- A highly effective people manager and have experience in vendor management
- Strong analysis skills and ability to interface a variety of software tools
- Excel skills are mandatory
Benefits
- Medical, Dental & Vision
- 401(k) Matching
- Paid Time Off
- Hybrid Work Model
- Flexible Work Arrangements
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.