Supervisor, Reimbursement - Follow Up & Appeals (Monday - Friday)

Company Description

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.

Job Description

Monday through Friday Shift

As a Supervisor, Reimbursement - Follow Up & Appeals, you play an important role in the overall success of the company and oversight to a dedicated team of Individual Contributors. This role is pivotal in driving sustainable improvements in Average Sale Price (ASP) and overall revenue cycle performance by leading, mentoring, and optimizing processes within the Department. The role requires a collaborative, proficient in data analysis, process optimization, and cross-functional coordination, committed to maintaining high standards in claim adjudication and fostering a culture of continuous quality enhancement.

You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values. You are responsible for facilitating efficiency improvements such as: Claims and Appeal Follow-up, EDI/ERA/EFT enrollments, lockbox improvements, eligibility validations, and provider payer portal registration properly and timely. This includes managing day-to-day activities and provides guidance to the team to ensure accurate and timely documentation for services related to the members claim and/or appeal. 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, compliance processes, regulations or compliance issues.
• Assist Revenue Cycle Manager Leadership with proactively auditing claims and collections in accordance with all third-party contract terms including, Medicare, managed care, commercial insurance, and direct patient pay.
• Assure maximization of cash collections through organized, diligent and timely focused monitoring of all open accounts’ receivable balances.
• Analyze reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management. Presents findings to leadership and develop action plans to mitigate risks.
• Prepare detailed analyses and reports of billing and accounts receivable activity and results, including performance matrixes, bad debt expense and AR days outstanding.
• Coordinate and participate in the audits of billing records to ensure accurate and complete data has been submitted for billing, along with payment receipt and subsequent posting of monies, contractual adjustments, etc...
• Assists in the development of department Standard Operating Procedures (SOPs) according to the Clinical Laboratory Standards Institute (CLSI) guidelines.
• Maintain and enhance billing policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies, procedures and due dates.
• Evaluates team key performance indicators (KPIs) and provides feedback regarding performance, development goals, and career competencies.
• Provides coaching and guidance to individual contributors, to ensure accurate and timely documentation for services and improve processing and quality of clean claims and appeal submissions. Ensuring billing is submitted for payment within pre-established deadlines.
• Assists with onboarding, hiring, and training individual contributors. 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 reconsideration/appeals 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.

Qualifications

• 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.

Additional Information

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.

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/