Supervisor, Reimbursement - Prior Authorization

About the Role

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

You are responsible for facilitating the prior authorization request process to ensure the work queue is managed properly and timely. You will manage day-to-day activities and provide 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 members' healthcare eligibility and access. Strong communication and troubleshooting skills are required.

Responsibilities

• Serve as the knowledge expert and information source for staff and key stakeholders.
• Ensure the authorization team’s compliance with contract requirements, policies, procedures, and performance standards.
• Monitor authorization requests inventory to ensure proper resource allocation throughout the day.
• Maintain 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.
• Work with the authorization team and senior management to identify opportunities for process and quality improvements within authorization request processes.
• Evaluate authorization team performance and provide feedback regarding performance, goals, and career milestones.
• Provide coaching and guidance to the authorization team to meet department productivity goals, ensuring accurate and timely documentation for services and improving processing and quality of authorization requests.
• Proactively monitor for organizational risks, communicate risks to leadership, and develop action plans to mitigate risks.
• Assist with onboarding, hiring, and training authorization team members. Participate in developing and/or updating job aids, training modules, workflows, and implementing change management strategies.
• Manage the import and export of documents through insurance portals, ensuring timely submission of prior authorization requests, accuracy, and compliance with procedures.
• Follow appropriate HIPAA guidelines.
• Work well individually and in a team environment to accomplish set KPI goals.
• Perform other related duties as assigned to support the overall efficiency of the department.

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

• Participating in corporate events and quarterly/biannual/annual meetings to connect with fellow leaders and share innovative strategies.
• Engaging in leadership development opportunities and conferences to enhance skills and knowledge.
• Initiating and participating in team-building activities in person with direct reports and collaborating with cross-functional teams to foster a strong, united workplace culture.

Requirements

• High school diploma or equivalent degree from an accredited college or university in business, healthcare administration, or a related major (relevant experience may be considered in lieu of degree).
• A minimum of 3 years of recent experience in professional healthcare revenue cycle management, and at least 1 year of related experience in a leadership role.
• Excellent leadership and team management skills.
• Exceptional attention to detail and accuracy.
• Knowledge of medical terminology, CPT, and ICD coding.
• Knowledge of managed care requirements as they relate to reimbursement; knowledge of US Commercial, Medicare, Medicaid, and third-party payer reimbursement preferred.
• Experience with contacting and following up with insurance carriers, filing reconsideration requests, formal appeals, and negotiations (preferred).
• Proficiency using a computer, PC software (specifically Microsoft Office Suite, particularly Excel), and 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 is 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 collaborate with a variety of professionals.
• Strong decision-making and self-motivation skills.
• Strong problem-solving skills and ability to troubleshoot issues effectively.
• 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.

Work Environment

• Majority of the work is performed in a desk/office environment; ability to sit/stand for extended periods of time.
• Employee may be required to lift routine office supplies and use office equipment.
• There may be exposure to high noise levels, fumes, and biohazard material in the laboratory environment.

Schedule

Hybrid Work Model: This role is eligible for hybrid work location as specified by management and related policies. All U.S. employees who live within 50 miles of a Guardant facility will be required to be onsite on Mondays, Tuesdays, and Thursdays.

Pay

The annualized base salary ranges for this role are listed below. This range does not include benefits or, if applicable, bonus, commission, or equity. Each candidate’s compensation offer will be based on multiple factors including, but not limited to, geography, experience, education, job-related skills, job duties, and business need.

• Primary Location (Remote - Open Position, USA): $80,070 - $110,075
• Other US Locations: $80,070 - $110,075
• Colorado: $84,780 - $116,550