Manager, Revenue Cycle Management (RCM) - Appeals and Claims Follow Up, Screening

Guardant 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. The Guardant Health screening portfolio, including the Shield test, aims to address the needs of individuals eligible for cancer screening.

Position Summary:

The Manager of the Revenue Cycle Appeals and Claims Follow-up will provide strategic leadership and oversight to a dedicated team of people managers and individual contributors. This role is pivotal in driving sustainable improvements in Average Sale Price (ASP) and overall revenue cycle performance by leading, mentoring, and optimizing processes within the Department. The role requires a collaborative, adept in data analysis, process optimization, and cross-functional coordination, committed to maintaining high standards in claim adjudication and fostering a culture of continuous quality enhancement.

Key Responsibilities:

• Revenue Cycle Management:
  • Develop and implement policies and procedures for all stages of the revenue cycle to ensure maximum efficiency and compliance.
  • Oversee the claims process, including submission, follow-up, and resolution of denials identifying, analyzing, and reducing claim denials through effective process development and management of the appeal process.
  • Monitor key performance indicators (KPIs) and generate reports to track the effectiveness of revenue cycle activities.
  • Ensure patient billing inquiries are resolved promptly, maintaining a positive financial experience for patients.
  • Manage Letters of Agreement (LOA) negotiations and maintain relationships with payers to secure favorable contract terms and reimbursement rates.
• Team Leadership and Development:
  • Manage and mentor a team of people managers and individual contributors, conducting regular meetings to set priorities and address departmental needs.
  • Guide team growth by mentoring and supporting development, with a focus on ASP improvement and operational sustainability.
  • Train revenue cycle staff to ensure compliance with current healthcare regulations and practices.
• Cross-functional Collaboration:
  • Collaborate with cross-functional teams to identify and address inefficiencies impacting ASP and claims adjudication processes.
  • Work closely with clinical staff to ensure accurate appeals documentation for optimal reimbursement.
  • Partner with team members to support and expand the quality improvement initiatives, fostering a mindset of continuous improvement.
• Strategic Analysis and Optimization:
  • Collaborate with leadership, including senior leadership, to conduct in-depth data analysis that identifies inefficiencies and opportunities for improvement.
  • Propose and lead implementation of resource optimization initiatives that maximize ASP and enhance overall process efficiency.
  • Manage system configurations to maximize efficiency of the team and the revenue cycle.
• Process Improvement Monitoring:
  • Track and evaluate the effectiveness of ASP improvement efforts, recommending strategy adjustments as necessary to achieve long-term performance sustainability.
• Revenue Cycle Knowledge and Mentorship:
  • Provide guidance and coaching on appeals and claim follow-up methodologies, developing team members' technical and analytical skills.
  • Stay informed on industry trends and integrate best practices into the team's operations to maintain a competitive edge in revenue cycle management.

Travel Requirements:

This role may require some travel that may include, but is not limited to:

• Participating in corporate events and quarterly/biannually/annually meetings to connect with fellow leaders and share innovative strategies.
• Engaging in leadership development opportunities and conferences that will enhance your skills and knowledge, empowering you to lead your team effectively.
• Initiating and participating in teambuilding activities in person with your direct reports and collaborating with cross-functional teams to foster a strong, united workplace culture.

Qualifications

• Typically requires a university degree and typically 8 years of related experience; 6 years and a Master's degree; 3 years and a PhD; or PharmD/MD..
• 7+ years of experience in revenue cycle management, with a focus on claims and appeals.
• Proven leadership experience, with a minimum of 3 years Supervisory experience and proven strong mentoring and team-building abilities.
• Familiarity with laboratory billing, Xifin, Telcor, payer portals and national as well as regional payers throughout the US are a plus.
• Knowledge in managed care requirements as they relate to reimbursement knowledge of US Commercial, Medicare, Medicaid and third-party payer reimbursement preferred.
• Experience with contacting and follow up with insurance carriers, file reconsideration requests, formal appeals and negotiations (preferred).
• Must be proficient using a computer, PC software, specifically Microsoft Office Suite, particularly Excel, and have above average typing skills
• Analytical mindset with experience in data analysis and process optimization.
• Excellent communication and interpersonal skills to facilitate collaboration across departments.

This role offers a challenging yet rewarding opportunity for a dynamic leader ready to drive sustainable improvements in a high-impact area of revenue cycle management.

Hybrid Work Model: At Guardant Health, we have 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.

Work Environment

• Majority of the work is performed in a desk/office environment. Ability to sit/stand for extended periods of time.

The US base salary range for this full-time position is $101,200 to $136,660. The range does not include benefits, and if applicable, bonus, commission, or equity.The range displayed reflects the minimum and maximum target for new hire salaries across all US locations for the posted role with the exception of any locations specifically referenced below (if any).

For positions based in Palo Alto, CA or Redwood City, CA, the base salary range for this full-time position is $126,500 to $170,820. The range does not include benefits, and if applicable, bonus, commission, or equity.

Within the range, individual pay is determined by work location and additional factors, including, but not limited to, job-related skills, experience, and relevant education or training. If you are selected to move forward, the recruiting team will provide details specific to the factors above.

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 toPeopleteam@guardanthealth.com

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.

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Please visit our career page at:http://www.guardanthealth.com/jobs/