Reimbursement Specialist I - Prior Authorization - job 1 of 3

Guardant Health is a leading precision oncology company focused on guarding wellness and giving every person more time free from cancer. Founded in 2012, Guardant is transforming patient care and accelerating new cancer therapies by providing critical insights into what drives disease through its advanced blood and tissue tests, real-world data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in early-stage cancer, and treatment selection for patients with advanced cancer. For more information, visit guardanthealth.com and follow the company on LinkedIn, X (Twitter) and Facebook.

About the Role:

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.

Essential Duties and Responsibilities:

● 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.

● 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).

Preferred Qualifications:

● 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

Shift: 9:00am to 5:30pm Central time

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. 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 to [email protected]

A background screening including criminal history is required for this role. GH will consider qualified applicants with criminal arrest or conviction histories in a manner consistent with applicable law including but not limited to the LA County Fair Chance Policies and the Fair Chance Act (Gov. Code Section 12952).

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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