Reimbursement Specialist II – Prior Authorization – AM – PM Cst – Monday – Friday Shift
| Company | Guardant Health |
|---|---|
| Location | Spring, TX, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Senior |
Requirements
- 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.
Responsibilities
- 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, handling correspondence, and conducting 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.
- Help build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department.
Preferred Qualifications
- Experience with laboratory billing workflows and national/regional payer requirements is highly desirable.