Full-Time Reimbursement Specialist II

As a Reimbursement Specialist II, Payment Posting, you're a seasoned expert within the revenue cycle team, driving impact through deep knowledge of insurance processes, payer policy, and driving payment for our services. You play a key role in partnering with colleagues in Finance and Client Services while maximizing reimbursement outcomes for the organization.

You will facilitate optimized billing processes and operations that are aligned with Guardant Health’s mission and values.

Independently manage posting cash receipts and EOBs in the billing tool and ensure that daily cash from the lockbox is reconciled to patient accounts efficiently and accurately.

With your extensive background in healthcare billing and payer engagement, strong attention to detail is critical. Strong communication and troubleshooting skills are required to manage unbalanced remittance advice directly with payers.

Help build and maintain comprehensive documentation of payer requirements and support process improvement initiatives that increase efficiency and effectiveness across the department.

1. Analyze and interpret details from EOB/ERA files to ensure accurate posting of payments and adjustments against appropriate line-item service in a timely manner.
2. Posting all denied charges for appeals department
3. In-depth knowledge of healthcare remark/reason codes, advice codes, and definitions
4. Familiarity with credits, debits, adjustments, takebacks, patient responsibility, allowed amounts, deductibles, co-pays, and coinsurance
5. Understanding of denied charges, denial reasons, and claims adjudication processes
6. Allocating Patient Payments to the appropriate account in a timely manner
7. Manage credit card transactions including credits, refunds, and chargebacks
8. Reconciling all bank transactions while meeting monthly deadlines
9. Daily, monthly, quarterly, and annually reconcile credits and debit transactions received by the financial institution.
10. Manage incoming correspondence from various channels (fax, email, portal) and associate them with the relevant patient/insurance records.
11. Communicate effectively with cross-functional teams to identify and address inefficiencies impacting ASP and claims adjudication processes.
12. Investigate and resolve credit balances, missing payments, payment allocations or discrepancies related to claims/appeals.

Requirements:

• 2-4 years recent experience in both professional and facility health care claims posting, including knowledge of health plan regulations and processes with high volume and/or multiple accounts.
• Experience with contacting and follow up with insurance carriers; national as well as regional payers throughout the country.
• Experience with managing incoming transactions from multiple lockboxes, ACH credit/debits, wire transfers, manage credit card processing with multiple gateways and merchant accounts as well as check scanners.
• Proficiency with revenue cycle tools, experience with laboratory reimbursement workflows, EDI enrollment, Payer Portal setup & management, Telcor, Waystar Clearinghouse, and Sarbanes Oxley controls (SOX).
• Exceptional attention to detail, self-motivated, organizational abilities and driven to identify process improvements that enhance operational performance.
• Demonstrated proficiency with using computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel, and have above average typing skills.
• Ability to work independently and handle confidential and sensitive information with utmost discretion.
• Excellent communication and interpersonal skills to facilitate collaboration across department, with an ability to distill complex issues for both technical and non-technical audiences.

Additional Information:

• This role may require some travel.

Hybrid Work Model:

US hourly range for this full-time position is $22.39 to $30.79.

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