Reimbursement Specialist II

About the Role

As a Reimbursement Specialist II, Follow Up & Appeals, you will play a vital role in ensuring the financial success of our organization. Collaborating with our billing tool provider, finance, and client services teams, you will streamline billing operations, optimize reimbursement processes, and support the company's mission and values. This role will work PST hours.

Responsibilities

• Track, report, and resolve complex outstanding claims.
• Troubleshoot Explanation of Benefits (EOBs) and identify reasons for claim denials or low payments.
• Appeal non-covered or underpaid claims through external review channels.
• Follow up on unpaid claims to ensure timely resolution.
• Drive positive coverage determinations through external appeals.
• Maintain accurate documentation of payer communications, correspondence, and insurance research.

Requirements

• 2+ years’ experience in a healthcare reimbursement role
• Solid understanding of health plan regulations, billing processes, and payer interactions.
• Experience with appeals at state and external review levels (IRO/IRBs) is preferred.
• Organized with strong attention to detail
• Self-starter capable of working independently with minimal supervision
• Tech-savvy and analytical, able to troubleshoot complex issues
• Excellent written and verbal communication skills, especially in challenging scenarios
• Moderate proficiency in Excel (sorting, filtering, basic calculations)
• Familiarity with laboratory billing, Xifin, EDI enrollment, payer portals, merchant solutions, and national/regional payers is a plus.

Skills

• Demonstrate curiosity, sound judgment, and the ability to critically evaluate and responsibly leverage AI-enabled tools in accordance with company policies, ethical standards, and regulatory requirements to improve the efficiency, effectiveness, and quality of work.

Schedule

Hybrid Work Model: This role requires onsite presence on Mondays, Tuesdays, and Thursdays for employees living within 50 miles of a Guardant facility. The hybrid model supports both in-person collaboration and work-from-home flexibility.

Pay

The annualized base salary ranges for this role are:

• Primary Location (Remote-USA-CA): $24 - $33 per hour
• Other US Locations: $23 - $31 per hour
• Colorado: $24 - $33 per hour

Each candidate’s compensation offer will be based on factors including, but not limited to, geography, experience, education, job-related skills, job duties, and business need.