Supervisor, Reimbursement Appeals, Follow-up

🕒 August 18

🏄 California, Texas – Remote

🏄 California – Remote 🤠 Texas – Remote

💵 $94.2k - $129.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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

• Lead the day-to-day operations and performance of the Appeals and Claims Follow-Up team • Lead, coach, and develop team members while establishing expectations for productivity, quality, timeliness, and reimbursement performance • Monitor individual and team performance through operational metrics, dashboards, quality reviews, and reimbursement outcomes • Conduct regular team and individual meetings to establish priorities, address barriers, provide feedback, and identify development opportunities • Oversee appeals and claims follow-up for denied, underpaid, incorrectly processed, and outstanding claims • Develop payer-specific strategies for claim follow-up, reconsiderations, appeals, and escalations • Monitor inventory, aging, and filing deadlines; prioritize accounts and proactively manage backlogs • Serve as an escalation resource for complex reimbursement issues • Drive strategies to improve ASP, reimbursement outcomes, claim resolution, and revenue cycle performance • Analyze denial, payment, appeal, and payer trends to identify root causes and reimbursement opportunities • Develop and implement action plans addressing reimbursement gaps, recurring payer issues, and operational inefficiencies • Measure reimbursement initiatives and adjust strategies for scalable, sustainable improvements • Identify trends and translate findings into recommendations, training opportunities, and workflow improvements • Develop and maintain standardized workflows, SOPs, quality expectations, and performance metrics • Support technology, automation, and process improvement initiatives • Partner with Revenue Cycle leadership and cross-functional teams to resolve issues impacting claims and reimbursement • Communicate payer trends, reimbursement risks, operational barriers, and improvement opportunities to leadership and stakeholders • Maintain knowledge of payer policies, appeals processes, reimbursement requirements, and regulatory changes • Educate and coach team members on payer-specific requirements, reimbursement strategies, and claims follow-up best practices

🎯 Requirements

• 3 to 5 years of experience in healthcare revenue cycle management, reimbursement, claims follow-up, denials, or appeals • 1+ year of supervisory or people-leadership experience • Bachelor's degree in healthcare administration, business administration, finance, engineering, or a related field preferred; equivalent relevant experience will be considered • Strong understanding of healthcare claims adjudication, appeals, payer processes, reimbursement methodologies, and performance metrics • Demonstrated analytical, problem-solving, communication, and leadership skills • Must have Salesforce or XiFin experience • Experience with commercial, Medicare, Medicaid, Medicare Advantage, and other government or managed care payers preferred • Knowledge of CPT/HCPCS coding, payer medical policies, timely filing requirements, and appeal processes preferred • Ability to critically evaluate and responsibly leverage AI-enabled tools in accordance with company policies, ethical standards, and regulatory requirements • Background screening including criminal history is required • Ability to sit for extended periods of time • Ability to lift routine office supplies and use office equipment

🏖️ Benefits

• Hybrid work model with work-from-home days for eligible onsite employees • Reasonable accommodations during hiring processes • Equal opportunity employment