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Reimbursement Specialist, Prior Authorization (Spring, Texas)

Guardant Health

Reimbursement Specialist, Prior Authorization (Spring, Texas)

Spring, TX
Full Time
Paid
  • Responsibilities

    Job Description

    =============================================== THIS ROLE WORKS OUT OF OUR SPRING, TX OFFICE. DUE TO THE COVID 19 PANDEMIC GUARDANT HEALTH HAS TEMPORARILY CLASSIFIED THIS ROLE AS ‘WORKING FROM HOME STATUS,’ SCHEDULED TO RETURN ONSITE IN SPRING, TX WHEN IT IS DETERMINED SAFE TO DO SO.

    As a REIMBURSEMENT AND PRIOR AUTHORIZATION SPECIALIST LOCATED IN SPRING, TEXAS you play an important role in the overall success of the company. Working with our billing tool provider, and partnering with colleagues in Finance and Client Services, you will drive payment by contacting insurance companies to secure preauthorization required for patients to receive our services. You will ensure information obtained is complete and accurate, follow up on requests, and apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements and online eligibility/preauthorization systems. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.

    You will help develop and maintain a database of payer authorization requirements, and manage documentation for appropriate payer communication, correspondence, and insurance claim research. You’re responsible for tracking, reporting and addressing complex outstanding claims. You will work to troubleshoot EOBs, appeal non-covered and inappropriately adjudicated claims, follow-up on claims, and drive positive coverage determinations through external appeals.

  • Qualifications

    Qualifications

    You are interested in being on the ground floor of a dynamic, fast paced organization. You are organized, have strong attention to detail, and are a self-starter who can work with minimal supervision. Tech savvy and analytical, you enjoy unpacking and resolving complex issues. Customer service is in your DNA, and you are known for your ability to communicate effectively through even the most tangled scenarios.

    Your background includes three years of work experience in a healthcare environment focused on healthcare reimbursement, including knowledge of health plan regulations and processes.  Your previous experience in similar roles enables you to hit the ground running and contribute insights and solutions to your team.

    You should have moderate Excel skills, like the ability to sort, filter and perform simple calculations. You have experience working with a broad range of payers and have experience coordinating with insurance providers, physicians, and patients to obtain prior authorizations.  You have also appealed to state level agencies or external level review with IRO/IRBs.

    Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals and national as well as regional payers throughout the country are a plus.

    Additional Information

    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 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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  • Industry
    Legal Services