Reimbursement Specialist II - Follow Up & Appeals at Guardant Health

Job Description

(This position is Full-Time; will consider Full-Time Remote, 3-Days Hybrid, and 5-Days Onsite Options, S
hift: Monday - Friday 8:00 AM - 5:00 PM PST)

As a Reimbursement Specialist II, Follow Up & Appeals, you will play a vital role in ensuring the financial success of our organization. Collaborating with our billing tool provider, finance, and client services teams, you will streamline billing operations, optimize reimbursement processes, and support the company's mission and values.

Essential Duties and Responsibilities:

Track, report, and resolve complex outstanding claims.
Troubleshoot Explanation of Benefits (EOBs) and identify reasons for claim denials or low payments.
Appeal non-covered or underpaid claims through external review channels.
Follow up on unpaid claims to ensure timely resolution.
Drive positive coverage determinations through external appeals.
Maintain accurate documentation of payer communications, correspondence, and insurance research.

0-2 years’ experience in a healthcare reimbursement role
Solid understanding of health plan regulations, billing processes, and payer interactions.
Experience with appeals at state and external review levels (IRO/IRBs) is preferred.
Organized with strong attention to detail
Self-starter capable of working independently with minimal supervision
Tech-savvy and analytical, able to troubleshoot complex issues
Excellent written and verbal communication skills, especially in challenging scenarios
Moderate proficiency in Excel (sorting, filtering, basic calculations)
Familiarity with laboratory billing, Xifin, EDI enrollment, payer portals, merchant solutions, and national/regional payers is a plus.

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).
For positions based in Palo Alto, CA or Redwood City, CA, the hourly range for this full-time position is $26.35 to $36.23. The range does not include benefits and, if applicable, overtime, bonus, commission, or equity.
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 to Peopleteam@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/