Reimbursement Specialist I - Follow Up and Appeals

As a Reimbursement Specialist – Follow Up and Appeals, 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’re responsible for tracking, reporting and addressing complex outstanding claims. You will work to troubleshoot EOBs, appeal non-covered & low pay claims, follow-up on claims, and drive positive coverage determinations through external appeals. You will manage documentation for appropriate payer communication, correspondence, and insurance claim research.
Essential Duties and Responsibilities:
• Accurate data entry of information into computer systems including notating accounts accurately
• Provide reimbursement assistance to patients while providing superior customer service and respect to patients and their families
• Resolves most patient concerns or complaints without escalation
• Effectively verify and communicate to patients and their families insurance eligibility, billing, collections and payment responsibilities
• Proves track record of written appeals with success
• Correctly interpret EOB’s for follow-up and/or appeals
• Follow appropriate HIPAA guidelines provide medical records to primary care provider, insurance carriers, referred providers and patients per patient request
• Work well individually and in a team environment accomplishing set goals
• Performs other related duties as assigned

Requirements

• A minimum of 1 year of recent experience in both professional and facility coding, billing, and collections with high volume and/or multiple accounts
• Experience with contacting and following up with insurance carriers on denials, filing reconsideration requests, formal appeals, and negotiations
• Experience working with a broad range of payers and have appealed to state-level agencies or external-level review with IRO/IRBs.
• Basic math skills to accurately interpret payment & adjustment transactions (must be able to read & understand an EOB)
• Must be proficient using a computer, and data entry, and have above average typing skills
• Intermediate to advanced MS Office including Excel
• Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals, and national as well as regional payers throughout the country is a plus
• High school diploma or equivalent