Clinical Payer Policy Analyst
Offer summary
Qualifications:
Minimum of 2 years experience in healthcare reimbursement, clinical review, or claims management., Strong understanding of billing, reimbursement, and regulatory processes., Proficiency with clinical documentation, appeal writing, and denials management., Educational background preferred: MS, CGC, MSN, RN license, or relevant degrees..Key responsibilities:
- Review and interpret complex clinical records related to payer policies.
- Analyze coverage data to support payer negotiations and strategic objectives.
- Collaborate with appeals teams to evaluate outcomes and craft rebuttals.
- Support clinical teams in prior authorization and patient access by providing medical expertise.
Job description
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 into what drives disease through its advanced blood and tissue tests, realworld data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in earlystage 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.
Job DescriptionAbout the Role:
The Clinical Payer Policy Analyst plays a critical role in supporting our precision medicine offerings through policy development, payer engagement, and reimbursement strategy. You will analyze payer policies, interpret complex medical records, and collaborate with crossfunctional teams to shape reimbursement pathways for nextgeneration sequencing (NGS) assays. Your insights will help refine appeals, address insurance denials, and influence payer policies to ensure patients have access to vital diagnostics.
Essential Duties and Responsibilities:
- Review and interpret complex clinical records related to payer policies, including Medicare and Medicaid
- Analyze coverage data to inform strategic objectives and support payer negotiations
- Collaborate with appeals teams to evaluate outcomes, craft compelling rebuttals, and update appeal documentation as needed
- Work crossfunctionally with teams outside reimbursement, including clinical, regulatory, and client services, to ensure alignment
- Provide training and ongoing support to appeals teams on clinical and policy matters
- Assist the Senior Manager with external appeals, liaising with IROs and regulatory agencies
- Review denial letters, document rationale, and gather relevant literature for addressing deficiencies in reviews
- Support clinical teams in prior authorization, patient access, and client services by providing medical expertise
- Conduct evidence searches, leveraging internal resources and external experts to support coverage decisions
- Stay informed on regulatory developments and policy changes impacting specialty testing and NGS reimbursement
- Perform additional duties to support team goals and company initiatives
Qualifications- 2+ years of experience in healthcare reimbursement, clinical review, or claims management
- Experience working with a variety of payers, including appeals to state agencies and external review organizations
- Strong understanding of billing, reimbursement, and regulatory processes
- Proficiency with clinical documentation, appeal writing, and denials management
- Educational background: MS, CGC, MSN, RN license, or relevant degrees preferred
- Familiarity with laboratory billing systems, payer portals, and regionalnational payers a plus
- Strong analytical, problemsolving, and communication skills
- Techsavvy with Excel and data analysis tools
- Organized, proactive, and able to manage multiple priorities
Additional Information
Hybrid Work Model: At Guardant Health, we have defined days for inpersononsite collaboration and workfromhome days for individualfocused 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 inoffice 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 worklife balance while keeping teams connected to advance our science for our patients.
The US base salary range for this fulltime position is $65,030 to $89,420. 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 fulltime position is $76,500 to $105,200. 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, jobrelated 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 deskoffice 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, longterm conditions, mental health conditions, or sincerely held religious beliefs. If you need support, please reach out to [email protected]
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.comjobs
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 into what drives disease through its advanced blood and tissue tests, realworld data and AI analytics. Guardant tests help improve outcomes across all stages of care, including screening to find cancer early, monitoring for recurrence in earlystage 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.
Job DescriptionAbout the Role:
The Clinical Payer Policy Analyst plays a critical role in supporting our precision medicine offerings through policy development, payer engagement, and reimbursement strategy. You will analyze payer policies, interpret complex medical records, and collaborate with crossfunctional teams to shape reimbursement pathways for nextgeneration sequencing (NGS) assays. Your insights will help refine appeals, address insurance denials, and influence payer policies to ensure patients have access to vital diagnostics.
Essential Duties and Responsibilities:
- Review and interpret complex clinical records related to payer policies, including Medicare and Medicaid
- Analyze coverage data to inform strategic objectives and support payer negotiations
- Collaborate with appeals teams to evaluate outcomes, craft compelling rebuttals, and update appeal documentation as needed
- Work crossfunctionally with teams outside reimbursement, including clinical, regulatory, and client services, to ensure alignment
- Provide training and ongoing support to appeals teams on clinical and policy matters
- Assist the Senior Manager with external appeals, liaising with IROs and regulatory agencies
- Review denial letters, document rationale, and gather relevant literature for addressing deficiencies in reviews
- Support clinical teams in prior authorization, patient access, and client services by providing medical expertise
- Conduct evidence searches, leveraging internal resources and external experts to support coverage decisions
- Stay informed on regulatory developments and policy changes impacting specialty testing and NGS reimbursement
- Perform additional duties to support team goals and company initiatives
Qualifications- 2+ years of experience in healthcare reimbursement, clinical review, or claims management
- Experience working with a variety of payers, including appeals to state agencies and external review organizations
- Strong understanding of billing, reimbursement, and regulatory processes
- Proficiency with clinical documentation, appeal writing, and denials management
- Educational background: MS, CGC, MSN, RN license, or relevant degrees preferred
- Familiarity with laboratory billing systems, payer portals, and regionalnational payers a plus
- Strong analytical, problemsolving, and communication skills
- Techsavvy with Excel and data analysis tools
- Organized, proactive, and able to manage multiple priorities
Additional Information
Hybrid Work Model: At Guardant Health, we have defined days for inpersononsite collaboration and workfromhome days for individualfocused 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 inoffice 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 worklife balance while keeping teams connected to advance our science for our patients.
The US base salary range for this fulltime position is $65,030 to $89,420. 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 fulltime position is $76,500 to $105,200. 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, jobrelated 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 deskoffice 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, longterm conditions, mental health conditions, or sincerely held religious beliefs. If you need support, please reach out to [email protected]
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.comjobs
About the Role:
The Clinical Payer Policy Analyst plays a critical role in supporting our precision medicine offerings through policy development, payer engagement, and reimbursement strategy. You will analyze payer policies, interpret complex medical records, and collaborate with crossfunctional teams to shape reimbursement pathways for nextgeneration sequencing (NGS) assays. Your insights will help refine appeals, address insurance denials, and influence payer policies to ensure patients have access to vital diagnostics.
Essential Duties and Responsibilities:
- Review and interpret complex clinical records related to payer policies, including Medicare and Medicaid
- Analyze coverage data to inform strategic objectives and support payer negotiations
- Collaborate with appeals teams to evaluate outcomes, craft compelling rebuttals, and update appeal documentation as needed
- Work crossfunctionally with teams outside reimbursement, including clinical, regulatory, and client services, to ensure alignment
- Provide training and ongoing support to appeals teams on clinical and policy matters
- Assist the Senior Manager with external appeals, liaising with IROs and regulatory agencies
- Review denial letters, document rationale, and gather relevant literature for addressing deficiencies in reviews
- Support clinical teams in prior authorization, patient access, and client services by providing medical expertise
- Conduct evidence searches, leveraging internal resources and external experts to support coverage decisions
- Stay informed on regulatory developments and policy changes impacting specialty testing and NGS reimbursement
- Perform additional duties to support team goals and company initiatives
- 2+ years of experience in healthcare reimbursement, clinical review, or claims management
- Experience working with a variety of payers, including appeals to state agencies and external review organizations
- Strong understanding of billing, reimbursement, and regulatory processes
- Proficiency with clinical documentation, appeal writing, and denials management
- Educational background: MS, CGC, MSN, RN license, or relevant degrees preferred
- Familiarity with laboratory billing systems, payer portals, and regionalnational payers a plus
- Strong analytical, problemsolving, and communication skills
- Techsavvy with Excel and data analysis tools
- Organized, proactive, and able to manage multiple priorities
Additional Information
Hybrid Work Model: At Guardant Health, we have defined days for inpersononsite collaboration and workfromhome days for individualfocused 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 inoffice 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 worklife balance while keeping teams connected to advance our science for our patients.
The US base salary range for this fulltime position is $65,030 to $89,420. 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 fulltime position is $76,500 to $105,200. 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, jobrelated 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 deskoffice 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, longterm conditions, mental health conditions, or sincerely held religious beliefs. If you need support, please reach out to [email protected]
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.comjobs
Qualifications
Required profile
Experience
Other Skills
- Analytical Skills
- Proactivity
- Communication
- Problem Solving
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