Supervisor, Reimbursement - Prior Authorization

Guardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary tests, vast data sets and advanced analytics. The Guardant Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum. Guardant Health has commercially launched Guardant360®, Guardant360 CDx, Guardant360 TissueNext™, Guardant360 Response™, and GuardantOMNI® tests for advanced stage cancer patients, and Guardant Reveal™ for early-stage cancer patients. The Guardant Health screening portfolio, including the Shield™ test, aims to address the needs of individuals eligible for cancer screening.

Monday - Friday Shift

As a Supervisor, Reimbursement Prior Authorization, you play an important role in the overall success of the company. Working with our billing tool provider, you will drive payment for our services, and by partnering with colleagues in Finance and Client Services. You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.

You are responsible for facilitating the prior authorization request process for required authorizations to ensure work queue is managed and addressed properly and timely. Manage day-to-day activities and provides guidance to the authorization team on documenting and resolving all authorization requests and/or issues to ensure accurate and timely documentation for services related to the members healthcare eligibility and access. You will be expected to be knowledgeable of, and be able to perform, the duties of the staff supervised. Strong communication and troubleshooting skills are required.

Essential Duties and Responsibilities:

• Serve as the knowledge expert and information source for staff, key stake holders,
• Ensures authorization team’s compliance with contract requirements, policies, procedures, and performance standards
• Monitors authorization requests inventory to ensure proper resources allocation throughout the day
• Maintains knowledge of contract requirements, policies, procedures, and performance standards
• Assist in the reimbursement appeals process by providing chronological documentation/tracking of prior-authorization verification and advisor follow-up for cases under review.
• Works with authorization team and senior management to identify opportunities for process and quality improvements within authorization request processes
• Evaluates authorization team performance and provides feedback regarding performance, goals, and career milestones
• Provides coaching and guidance to authorization team and department productivity goals to ensure accurate and timely documentation for services and improve processing and quality of authorization requests
• Proactively monitor for organization risks, communicates risks to leadership and develop action plans to mitigate risks
• Assists with onboarding, hiring, and training authorization team members. Participates in developing and/or updating job aids, training modules, workflows and implements change management strategies
• Manage the import and export of documents through insurance portals, ensuring timely submission of prior authorization requests, ensuring accuracy and compliance with procedures
• Follow appropriate HIPAA guidelines
• Work well individually and in a team environment accomplishing set KPI goals
• Performs other related duties as assigned to support the overall efficiency of the department

Travel Requirements:

This role may require some travel that may include, but is not limited to:

• Participating in corporate events and quarterly/biannually/annually meetings to connect with fellow leaders and share innovative strategies.
• Engaging in leadership development opportunities and conferences that will enhance your skills and knowledge, empowering you to lead your team effectively.
• Initiating and participating in teambuilding activities in person with your direct reports and collaborating with cross-functional teams to foster a strong, united workplace culture.

• High school diploma or equivalent degree from an accredited college or university in business, healthcare administration or related major (relevant experience may be considered in lieu of degree)
• A minimum of 3-years of recent experience in both professional healthcare revenue cycle management, and at least 1 year of related experience in a leadership role reflective of the level of this position
• Excellent leadership and team management skills
• Exceptional attention to detail and accuracy
• Knowledge of medical terminology CPT and ICD coding
• Knowledge in managed care requirements as they relate to reimbursement knowledge of US Commercial, Medicare, Medicaid and third-party payer reimbursement preferred
• Experience with contacting and follow up with insurance carriers, file reconsideration requests, formal appeals and negotiations (preferred)
• Must be proficient using a computer, PC software, specifically Microsoft Office Suite, particularly Excel, and have above average typing skills
• Excellent communication skills, both written and verbal
• Familiarity with laboratory billing, Xifin, Telcor, payer portals and national as well as regional payers throughout the country are a plus
• Ability to effectively incorporate the mission and core values into processes and workflows
• Effective interpersonal skills to facilitate work in a team environment and to collaborate with a variety of professionals
• Strong decision making and self-motivation skills
• Strong problem-solving skills and ability to troubleshoot issues effectively

Work Environment

Majority of the work is performed in a desk/office environment. Ability to sit/stand for extended periods of time.

Hybrid Work Model: At Guardant Health, we have 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. We have found aligning our scheduled in-office days allows our teams to do the best work and creates the focused thinking time our innovative work requires. At Guardant, our work model has created flexibility for better work-life balance while keeping teams connected to advance our science for our patients.

The US base salary range for this full-time position is $75,500 to $120,800. The range does not include benefits, and if applicable, bonus, commission, or equity. The range displayed reflects the minimum and maximum target for new hire salaries across all US locations for the posted role with the exception of any locations specifically referenced below (if any).

For positions based in Palo Alto, CA or Redwood City, CA, the base salary range for this full-time position is $100,700 to $135,900. The range does not include benefits, and if applicable, bonus, commission, or equity.

Within the range, individual pay is determined by work location and additional factors, including, but not limited to, job-related skills, experience, and relevant education or training. If you are selected to move forward, the recruiting team will provide details specific to the factors above.

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.

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. If you need support, please reach out to [email protected]

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 and will not be discriminated against on the basis of disability.

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

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Please visit our career page at: http://www.guardanthealth.com/jobs/