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
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