Director, Reimbursement Operations

Company: Guardant Health
Location: Redwood City
Posted on: February 22, 2021

Job Description:

Company DescriptionGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary blood 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 launched liquid biopsy-based Guardant360--, Guardant360 CDx and GuardantOMNI-- tests for advanced stage cancer patients. These tests fuel development of its LUNAR program, which aims to address the needs of early-stage cancer patients with neoadjuvant and adjuvant treatment selection, cancer survivors with surveillance, asymptomatic individuals eligible for cancer screening and individuals at a higher risk for developing cancer with early detection.Job Description====================================This role works out of our Redwood City, CA office.Due to the Covid 19 Pandemic Guardant Health has temporarily classified this role as 'working from home status,' scheduled to return onsite in Redwood city, CA when it is determined safe to do so.====================================Position SummaryThe Director of Reimbursement 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. These skills would include eligibility automation, prior authorization automation, LIMS integration with the cloud sourced billing tool and Salesforce. 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.* Oversees the design and build a Patient Financial Assistance Program.* 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 ASP for productsQualifications* 5+ years professional experience in Reimbursement and Billing in a life sciences, payer setting* 5+ years management experience with a billing team* Bachelor's degree required; graduate degree in a related field such as public health or public policy preferred* Experienced working with payers as a laboratory that bills molecular tests.* Experience and knowledge of federal and state legislative environments and regulatory processes to dissect complex scenarios and are able to bring issues to swift resolution.* Expert in medical billing, third party payers and patient interface, patient privacy and confidentiality paramount.* Follow payer policy activities on coverage and payment technology processes and practices* In-depth knowledge of SOP development in a HIPAA-compliant environment and molecular billing codes and regulations.* A highly effective people manager and have experience in vendor management, with a keen focus on optimizing processes and practices in a rapidly changing environment.* Program management and systems engineering skills are a significant plus to assist with process design.* Strong analysis skills and ability to interface a variety of software tools to quickly perform analyses to answer questions and make decisions. Excel skills are mandatory, SQL or other databasing skills are desireableAdditional InformationEmployee 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, Redwood City , Director, Reimbursement Operations, Executive , Redwood City, California