Job Description

As a Reimbursement Specialist II – Prior Authorization, you are a seasoned expert within the revenue cycle team, driving impact through deep knowledge of insurance processes, payer policy, and prior authorization strategy. You play a key role in ensuring patients receive timely access to care while maximizing reimbursement outcomes for the organization.

You will independently manage the full prior authorization lifecycle—navigating complex payer policies, securing timely approvals, and resolving escalated reimbursement issues. With your extensive background in healthcare billing and payer engagement, you will lead efforts to streamline processes, troubleshoot complex denials, and collaborate with team members and ordering physician offices to ensure seamless communication.

In collaboration with Finance, Client Services, Account Managers, and our billing technology partners, you will champion best practices and contribute to a high-functioning, compliant billing operation. You’ll help build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department.

Key Responsibilities:

Revenue Cycle Management:

• Manage the full prior authorization lifecycle, including navigating complex payer policies and securing timely approvals.
• Actively review, submit, track and resolve Prior Authorization inquiries using appropriate systems and tools (SalesForce/Telcor/Emails/Fax/Phone/Portals) until final approval is obtained.
• Resolve escalated rejected authorizations issues and streamline processes for efficiency.
• Research system notes to obtain missing or corrected insurance or demographic information.
• Prepare and submit necessary medical records, documentation, and justification to insurance companies.
• Ensure all required documentation is complete and accurate to avoid delays in authorization.
• Manage faxes, emails, phone calls and respond to voicemails and emails.
• Maintain comprehensive documentation of payer requirements and support process improvement initiatives.
• Follow appropriate HIPAA guidelines.
• Performs other added responsibilities as assigned to support the overall efficiency of the department.
• All job duties must be performed in a manner that demonstrates the company Leadership Attributes and support of the Mission & Values of the company.

Cross-functional Collaboration:

• Communicate effectively with cross-functional teams and ordering physician offices to identify and address inefficiencies impacting ASP and claims adjudication processes.
• Work closely with staff to investigate and resolve delays, rejections, or discrepancies related to claims submissions for optimal reimbursement.

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+ years of healthcare reimbursement experience, with a strong focus on prior authorization, insurance coordination, payer relations and appeals.
• Expert-level knowledge of Medicare, Medicaid, IPA and commercial payer authorization policies and appeals processes.
• Demonstrated success in managing complex, high-priority claims, including overturning denials through advanced appeal strategies and external reviews.
• Proficiency with revenue cycle tools and systems such as Xifin/Telcor, payer portals, and Salesforce.
• 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.
• Experience with laboratory billing workflows and national/regional payer requirements is highly desirable.
• Demonstrated proficiency with using a computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel, and have above average typing skills
• Experience with contacting and follow up with insurance carriers.
• 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.

Work Environment:

Majority of the work is performed in a desk/office environment. Ability to sit/stand for extended periods of time, use hands to type data, and utilize a PC/Laptop or other standard communication methods (email, phone, fax, etc..) to complete job-related responsibilities as assigned.

Additional Information

** Hybrid Work Model** : At Guardant Health, we have 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 US hourly range for this full-time position is $22.39 to $30.79. The range does not include benefits and, if applicable, overtime, bonus, commission, or equity. The range displayed reflects the minimum and maximum target for new hire salaries across all US locations for the posted role with the exception of any locations specifically referenced below (if any).

Within the range, individual pay is determined by work location and additional factors, including, but not limited to, job-related skills, experience, and relevant education or training. If you are selected to move forward, the recruiting team will provide details specific to the factors above.

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 toPeopleteam@guardanthealth.com

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.

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Please visit our career page at:http://www.guardanthealth.com/jobs/