Associate Director, Reimbursement Operations (REMOTE)

Company: Guardant Health
Location: Palo Alto
Posted on: June 20, 2022

Job Description:

Company DescriptionGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary tests, vast data sets and advanced analytics. The Guardant Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum. Guardant Health has commercially launched Guardant360 -, Guardant360 CDx, Guardant360 TissueNext---, Guardant360 Response---, and GuardantOMNI - tests for advanced stage cancer patients, and Guardant Reveal--- for early-stage cancer patients. These tests fuel development of its screening program, which aims to address the needs of asymptomatic individuals eligible for cancer screening.Job Description(This position is open to REMOTE candidates, however, preference will be given to those who are based in the San Francisco Bay Area.)Reimbursement Operations is a critical function that fuels our mission to conquer cancer with data. The Associate Director of Reimbursement Operations plays a key leadership role in managing our operations with insurance payors, patients, clients, and internal stakeholders. The ideal candidate is one who is a highly effective leader who can drive improvements and manage multiple projects effectively.The Associate Director of Reimbursement Operations has in-depth expertise in developing and implementing strategic and tactical reimbursement/market access initiatives in the US. A key focus of this position is to collaborate with Guardant Health insurance companies, physicians, hospitals and government agencies. The role is also focused on supporting internal and external customers as well as key stakeholders in all aspects of the reimbursement process. The internal support will rely heavily on program management software infrastructure projects to automate processes to maximize efficiency and claim reimbursement. The candidate should have significant knowledge in laboratory billing laws regulations and compliance activities to ensure that when interfacing with new product development they are able to provide guidance around the parameters required to successfully commercialize new tests. The candidate is highly skilled at developing relationships as well as working across the organization to achieve reimbursement and patient access goals that are aligned with sales and marketing strategies. Essential Duties and Responsibilities:

• Acts as company subject matter expert in billing and payment strategy focusing on optimizing revenue cycle management to achieve maximum reimbursement.
• Manages a team to ensure approval and correct processing of patient claims to insurance companies with high customer satisfaction.
• Partners with our internal resources to develop internal metrics and optimization strategies for data and history, enabling development of simple and easily accessible data that will be used to direct our reimbursement strategy for new and exsiting products.
• Oversees the strategy and development of internal operational policies and SOPs that will scale with the organization.
• Builds and sustains positive partnerships with Payers and Providers, to ensure processes are in place to ensure contracts are loaded and claims adjudication is managed in a manner consistent with contractual or regulatory language.
• Collaborates with internal and external stakeholders to successfully resolve challenges with patient billing and other provider issues.
• Manages and supports the operational and administrative process for billing, ensuring efficient, effective and compliant revenue cycle management.
• Interfaces regularly with finance to be able to help with FP&A as well as SOX and determination of average service price for productsQualifications
  • 5+ years professional experience with reimbursement and billing in laboratory diagnostics, revenue cycle consulting, or related-industry experience
  • 5+ years management experience with leading teams of 10+ people or more. We are looking for highly-effective leaders that can drive change.
  • Demonstrated track record for streamlining revenue cycle functions, particularly back-end functions such as payment posting, denials management, appeals management, and follow-up.
  • High proficiency with analytics tools and able to use them to help identify opportunities and make decisions. Strong Excel skills are a must. Salesforce, Tableau, and SQL a plus.
  • Strong knowledge of billing systems (specifically XIFIN) a major plus
  • Bachelor's degree required; graduate degree in a related field such as public health or public policy preferred
  • Experience working with payers as a laboratory that bills molecular tests
  • Knowledge of federal and state legislative environments and regulatory processes to dissect complex scenarios and are able to bring issues to swift resolution.
  • In-depth knowledge of SOP development in a HIPAA-compliant environment and molecular billing codes and regulations.
  • Program management and systems engineering skills are a significant plus to assist with process design.Additional InformationCovid Vaccination Policy: Starting January 7, 2022, Guardant Health will require all employees to be fully vaccinated to either (a) establish that they have been fully vaccinated against COVID-19; or (b) request and obtain an approved exemption from Guardant's COVID-19 U.S. Vaccination Policy as a reasonable accommodation, as consistent with applicable laws. An employee is considered fully vaccinated against COVID-19 two weeks after receiving the second dose of a two-dose vaccine or one dose of a single-dose vaccination. Acceptable vaccines are approved or under emergency use authorization by the U.S. Food and Drug Administration (FDA) and/or the World Health Organization (WHO). In addition, fully-vaccinated employees will be required to maintain their fully-vaccinated status under this policy by obtaining, if applicable, any FDA-approved boosters.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 an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.All your information will be kept confidential according to EEO guidelines.To learn more about the information collected when you apply for a position at Guardant Health, Inc. and how it is used, please review our Privacy Notice for Job Applicants.Please visit our career page at: http://www.guardanthealth.com/jobs/, , ,

Keywords: Guardant Health, Palo Alto , Associate Director, Reimbursement Operations (REMOTE), Executive , Palo Alto, California