Reimbursement Specialist II - Prior Authorization @Guardant Health

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

Apr 04, 2025 - Guardant Health is hiring a remote Reimbursement Specialist II - Prior Authorization. 💸 Salary: $22.39 to $30.80 per hour. 📍Location: USA.

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Role 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. Based in Spring, Texas, you play a key role in ensuring patients receive timely access to care while maximizing reimbursement outcomes for the organization.

Independently manage the full prior authorization lifecycle—navigating complex payer policies, securing timely approvals, and resolving escalated reimbursement issues.
Lead efforts to streamline processes, troubleshoot complex denials, and collaborate with team members and ordering physician offices to ensure seamless communication.
Manage documentation for appropriate payer communication, handle correspondence, and conduct insurance claim research.
Contribute to the development and implementation of training programs.
Champion best practices and contribute to a high-functioning, compliant billing operation in collaboration with Finance, Client Services, Account Managers, and billing technology partners.
Build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department.

Qualifications

Minimum of 5+ years of healthcare reimbursement experience, with a strong focus on prior authorization, insurance coordination, and payer relations.
Expert-level knowledge of Medicare, Medicaid, 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, payer portals, EDI enrollment, and merchant/payment solutions.
Advanced Excel capabilities, including use of pivot tables, conditional logic, and trend analysis for reporting and decision-making.
Proven track record of working cross-functionally with internal teams and external stakeholders to resolve reimbursement challenges.
Strong written and verbal communication skills, with an ability to distill complex issues for both technical and non-technical audiences.
Detail-oriented, self-motivated, and driven to identify process improvements that enhance operational performance.
Experience with laboratory billing workflows and national/regional payer requirements is highly desirable.

Requirements

Hybrid Work Model: 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.
The US hourly range for this full-time position is $22.39 to $30.80, not including benefits and, if applicable, overtime, bonus, commission, or equity.
For positions based in Palo Alto, CA or Redwood City, CA, the hourly range is $26.34 to $36.22.
Individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training.
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.

Benefits

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.
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.
All your information will be kept confidential according to EEO guidelines.

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📍	Be aware of the location restriction for this remote position: USA
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Reimbursement Specialist II - Prior Authorization @Guardant Health

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Salary 💸 $22.39 to $30.80 per hour	Remote Location USA
Job Type full-time	Posted Apr 04, 2025

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

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