Reimbursement Specialist II

🔥 2 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $24 - $33 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Guardant Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

Healthcare • Consulting • Food & Beverage

Guardant Health is a precision oncology company that specializes in using blood tests to revolutionize cancer care. Their innovative tests provide critical insights that help inform treatment decisions for patients across all stages of cancer. By leveraging advanced technology and data, Guardant Health aims to improve clinical outcomes and enhance the overall patient experience in the fight against cancer.

📋 Description

• 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 • Collaborate with the billing tool provider, finance, and client services teams to streamline billing operations and optimize reimbursement processes

🎯 Requirements

• 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 • Ability to work PST hours • Background screening including criminal history is required • Ability to sit for extended periods of time • May be required to lift routine office supplies and use office equipment

🏖️ Benefits

• Remote work arrangement • Flexible work-life balance through work-from-home days (where applicable) • Reasonable accommodations during hiring processes • Equal Opportunity Employer • Confidential handling of applicant information