Reimbursement Specialist II

Reimbursement Specialist II, Follow Up & Appeals Guardant Health is a leading precision oncology company focused on guarding wellness and giving every person more time free from cancer. Founded in 2012, Guardant® is transforming patient care and accelerating new cancer therapies by providing critical insights into what drives disease through its advanced blood and tissue tests, real-world data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in early-stage cancer, and treatment selection for patients with advanced cancer. 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. Essential Duties and 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. Qualifications 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. AI & Digital Fluency: 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. Hybrid Work Model: This section is applicable to onsite employees who are eligible for hybrid work location as specified by management and related policies. Guardant has 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 annualized base salary ranges for the primary location and any additional locations 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-USA-CA Primary Location Base Pay Range: $24 - $33 Other US Location(s) Base Pay Range: $23 - $31 If the role is performed in Colorado, the pay range for this job is: $24 - $33 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 View email address on click.appcast.io A background screening including criminal history is required for this role. Guardant Health