Job Details

Company Description

Guardant Health is a leading precision oncology company focused on guarding wellness and giving every person more time free from cancer. Founded in 2012, Guardant is transforming patient care and accelerating new cancer therapies by providing critical insights intowhat drives disease through its advanced blood and tissue tests, real-world data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in early-stage cancer, and treatment selection for patients with advanced cancer. For more information, visit guardanthealth.com and follow the company on LinkedIn, X (Twitter) and Facebook.

The Electronic Data Interchange (EDI) Enrollment Specialist will initiate, complete and maintain timely US health plan electronic exchange of information on behalf of Guardant Health with for Government and Commercial health carriers and external trading partners.

This role is pivotal in facilitating enrollment for new payers with the clearinghouse(s), but are not limited to, onboarding new payers, offboarding existing payers, implementing and maintaining existing systems, ensuring that data exchanges between different parties are accurate, reconciled and secured daily, as well as troubleshooting any enrollment issues that arise. The role requires collaborative, and cross-functional coordination with providers, clearinghouses (Waystar, Availity, etc..), insurance representatives, CAQH and others while maintaining high standards as a technical resource in all EDI areas.

The Electronic Data Interchange (EDI) Enrollment Specialist reports to leadership, including Associate Directors, the Director, and VP and supervises no staff.

Key Responsibilities:

• Revenue Cycle Management:
  • Prepare and submit applications to configure/establish EDI 837 (claims), 276/277 (claims status inquiry/response), 270/271 (eligibility files), ERA 835 (remittance) and EFT activities through clearinghouse, fax, email, mail and/or payer portals.
  • Initiate and manage investigations directly with payers and clearinghouses for provider enrollment denials and errors.
  • Review incoming payer correspondence and take appropriate actions to resolve issues.
  • Ensure claim inquiries and rejections are resolved promptly, maintaining a positive financial experience for patients.
  • Communicate with all internal teams and external stakeholders clearly and professionally via written and verbal channels.
  • Consistently achieve defined production and quality KPIs/metrics.
  • Follow appropriate HIPAA guidelines
  • Performs other related duties as assigned to support the overall efficiency of the department
• Cross-functional Collaboration:
  • Collaborate with cross-functional teams to identify and address inefficiencies impacting ASP and claims adjudication processes.
  • Work closely with staff to investigate and resolve enrollment delays, rejections, or discrepancies related to claims submissions for optimal reimbursement.
  • Collaborate with leadership, including Associate Directors, the Director, and VP, to conduct in-depth data analysis that identifies inefficiencies and opportunities for improvement.
  • Act as a liaison between Revenue Cycle Management (RCM) with Managed Care to discuss, investigate, and resolve enrollment inquiries, fostering a mindset of continuous quality improvement.
  • Work with Finance to keep up-to-date W9's & Bank letters.
• Process Improvement Monitoring:
  • Stay abreast of the latest EDI trends, technologies, and regulations in the healthcare industry, recommending strategy adjustments as necessary to achieve long-term performance sustainability.
  • Keep comprehensive records of credentialing activities, including applications, verifications, and accreditation within all systems, folders and trackers.

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 and share innovative strategies.
• Engaging in development opportunities and conferences that will enhance your skills and knowledge, empowering you to lead initiates effectively.
• Initiating and participating in team-building activities in person and collaborating with cross-functional teams to foster a strong, united workplace culture.

Qualifications

• 1-2 years of Healthcare Insurance Billing for Professional claims with a solid understanding of HCFA-1500 or equivalent work experience preferred
• Previous EFT - (Electronic Funds Transfer), ERA - (Electronic Remittance Advice)/835, EDI - (Electronic Data Interchange) experience is required (for medical billing or within healthcare).
• Thorough understanding of EDI requirements and daily operations of EDI systems, data flows, monitoring transmissions, and interfacing with partners.
• Demonstrated proficiency with using a computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel, and have above average typing skills
• Knowledge of electronic data concepts and systems including business process and systems analysis
• Familiarity with Clearinghouse Enrollments, Laboratory RCM Billing, Xifin, Telcor, US payer portals and national as well as regional payers throughout the US are a plus.
• Knowledge in industry-specific EDI documents and transactions 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, and Letters of Agreement (LOA) negotiations (preferred).
• Analytical mindset with experience in data analysis and process optimization.
• Ability to work independently as a self-starter and handle confidential and sensitive information with utmost discretion.
• Must be able to work cohesively in a team-oriented environment and be able to foster good working relationships with others both within and outside the organization
• 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:This section is applicable to onsite employees who are eligible for hybrid work location as specified by management and related policies. Guardant has 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.

The annualized base salary ranges for the primary location and any additional locations are listed below. This range does not include benefits or, if applicable, bonus, commission, or equity. Each candidate's compensation offer will be based on multiple factors including, but not limited to, geography, experience, education, job-related skills, job duties, and business need.Primary Location: Remote-USA-CAPrimary Location Base Pay Range: $24 - $33Other US Location(s) Base Pay Range: $23 - $31If the role is performed in Colorado, the pay range for this job is: $24 - $33

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 to ...@guardanthealth.com

A background screening including criminal history is required for this role. GH will consider qualified applicants with criminal arrest or conviction histories in a manner consistent with applicable law including but not limited to the LA County Fair Chance Policies and the Fair Chance Act (Gov. Code Section 12952).

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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