Reimbursement Specialist II – Follow-Up, Appeals

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $23 - $31 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Analyze and interpret EOB/ERA files to identify claim denials, errors, and low payments • Prepare and submit appeals for non-covered services, low payments, and disputed claims • Drive positive coverage determinations through external appeals • Escalate complex payment issues to ensure timely resolution • Track, report, and address complex outstanding claims • Maintain documentation of payer communications, claim statuses, correspondence, and research • Provide reimbursement assistance and customer service to patients and families • Verify and communicate insurance eligibility, billing, collections, and payment responsibilities • Enter and accurately notate account information in computer systems • Manage incoming correspondence through fax, email, and portals and associate it with patient and insurance records • Communicate with payers and internal stakeholders through email, fax, and other channels • Handle inbound and outbound calls regarding payment statuses and claim issues • Identify and report payer trends • Use spreadsheets for data analysis and reporting • Participate in training and education programs for role-related software and systems • Manage time and maintain accuracy in reimbursement and cash application tasks • Collaborate cross-functionally to identify and address claims adjudication and ASP inefficiencies • Investigate and resolve credit balances, missing payments, payment allocations, and claim or appeal discrepancies • Participate in corporate events, meetings, conferences, development opportunities, and in-person teambuilding activities as needed • Perform other assigned responsibilities

🎯 Requirements

• Minimum of 3-5 years recent experience in both professional and facility health care claims posting • Knowledge of health plan regulations and processes with high volume and/or multiple accounts • Experience contacting and following up with national and regional insurance carriers • Experience handling denials, reconsideration requests, formal appeals, and negotiations • Experience appealing to state-level agencies or external-level review with IRO/IRBs • Strong mathematical skills and ability to read and understand EOBs • Experience with revenue cycle tools and laboratory reimbursement workflows • Experience with EDI enrollment and payer portal setup and management • Telcor, Waystar Clearinghouse, and Sarbanes-Oxley controls (SOX) knowledge highly desirable • Proven cross-functional collaboration with internal teams and external stakeholders • Strong attention to detail, self-motivation, organizational abilities, and process-improvement focus • Proficiency with computer hardware, PC software, Microsoft Office Suite, Adobe Acrobat PDF, and Excel • Above-average typing skills • Analytical mindset with experience in data analysis and process optimization • Ability to work independently and handle confidential and sensitive information • Ability to work cohesively in a team-oriented environment • Excellent communication and interpersonal skills • Ability to critically evaluate and responsibly leverage AI-enabled tools according to company policies, ethical standards, and regulatory requirements • Must maintain confidentiality and adhere to HIPAA guidelines/regulations • Background screening including criminal history is required

🏖️ Benefits

• Hybrid work model for eligible onsite employees, with work-from-home days • Participation in corporate events and quarterly/biannual/annual meetings • Development opportunities and conferences • Teambuilding activities • Reasonable accommodations during hiring processes • Confidential handling of applicant information