[Hiring] Reimbursement Specialist I - Prior Authorization @Guardant Health

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Reimbursement and Prior Authorization Specialist, you are vital to our success. You will collaborate across teams to secure insurance preauthorizations, streamline billing operations, and ensure accurate and complete documentation, supporting our mission to advance cancer care. • Act as a primary contact for insurance companies to obtain necessary preauthorizations for patient services. • Collaborate with billing systems, finance, and client services teams to facilitate timely payment processing. • Maintain and update a comprehensive database of payer authorization requirements. • Manage all documentation related to payer communication, correspondence, and insurance claims research. • Track, report, and resolve complex claims, ensuring prompt follow-up and resolution. • Troubleshoot Explanation of Benefits (EOBs), identify claim issues, and escalate as needed. • Appeal non-covered or incorrectly adjudicated claims through external review processes. • Drive positive coverage decisions via appeals and external review organizations. • Ensure compliance with Medicare, Medicaid, and other third-party payer requirements and online eligibility/preauthorization systems. • Support continuous improvement of billing and authorization processes aligning with company values. Qualifications • 0-2 years of experience in the healthcare industry. • Strong understanding of health plan regulations, billing processes, and third-party payer requirements. • Excellent organizational skills, with high attention to detail and accuracy. • Self-motivated with the ability to work independently in a fast-paced environment. • Tech-savvy with proficiency in Excel (sorting, filtering, basic calculations). Requirements • Experience with insurance and payer relations. • Experience working with a diverse range of payers, insurance portals, and prior authorization processes. • Proven ability to coordinate with insurance providers, physicians, and patients. • Knowledge of laboratory billing, Xifin, EDI enrollment, and merchant solutions is a plus. • Experience with appeals at state and external review organizations (IROs/IRBs) is a plus. Benefits • The US hourly range for this full-time position is $20.53 to $28.24. • 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. Apply tot his job Apply To this Job