Position SummaryThe Supervisor, Revenue Cycle – Appeals and Claims Follow-Up is responsible for leading the day-to-day operations and performance of the Appeals and Claims Follow-Up team. This role oversees employees responsible for resolving denied, underpaid, and outstanding claims and developing effective appeal and follow-up strategies to maximize reimbursement.
The Supervisor is accountable for team productivity, quality, backlog management, and reimbursement outcomes, with a focus on improving ASP, accelerating claim resolution, and creating sustainable revenue cycle processes. This position requires strong leadership, analytical skills, reimbursement knowledge, and the ability to collaborate across teams to address systemic issues impacting revenue.
Key ResponsibilitiesTeam Leadership & Performance Management- Lead, coach, and develop team members while establishing clear expectations for productivity, quality, timeliness, and reimbursement performance.
- Monitor individual and team performance through operational metrics, dashboards, quality reviews, and reimbursement outcomes.
- Conduct regular team and individual meetings to establish priorities, address barriers, provide feedback, and identify development opportunities.
- Promote a culture of accountability, collaboration, continuous improvement, and ownership of results.
Appeals & Claims Follow-Up Operations- Oversee appeals and claims follow-up activities for denied, underpaid, incorrectly processed, and outstanding claims.
- Develop effective payer-specific strategies for claim follow-up, reconsiderations, appeals, and escalations to improve reimbursement.
- Monitor inventory, aging, and filing deadlines to ensure accounts are appropriately prioritized and backlogs are proactively managed.
- Serve as an escalation resource for complex reimbursement issues and ensure activities align with payer and regulatory requirements.
Revenue & ASP Optimization- Drive strategies focused on improving ASP, reimbursement outcomes, claim resolution, and overall revenue cycle performance.
- Analyze denial, payment, appeal, and payer trends to identify root causes and opportunities for increased reimbursement.
- Develop and implement action plans to address reimbursement gaps, recurring payer issues, and operational inefficiencies.
- Measure the effectiveness of reimbursement initiatives and adjust strategies to support scalable and sustainable improvements.
Data, Quality & Process Improvement- Identify trends and translate findings into actionable recommendations, training opportunities, and workflow improvements.
- Develop and maintain standardized workflows, SOPs, quality expectations, and performance metrics.
- Support technology, automation, and process improvement initiatives that reduce manual effort and improve operational efficiency.
Cross-Functional Collaboration & Payer Knowledge- Partner with Revenue Cycle leadership and cross-functional teams to identify and resolve upstream and downstream issues impacting claims and reimbursement.
- Communicate payer trends, reimbursement risks, operational barriers, and improvement opportunities to leadership and key stakeholders.
- Maintain current knowledge of payer policies, appeals processes, reimbursement requirements, and relevant regulatory changes.
- Educate and coach team members on payer-specific requirements, reimbursement strategies, and claims follow-up best practices.
Qualifications- 3 to 5 years of experience in healthcare revenue cycle management, reimbursement, claims follow-up, denials, or appeals, with 1+ year of supervisory or people-leadership experience.
- Bachelor's degree in healthcare administration, business administration, finance, engineering, or a related field preferred; equivalent relevant experience will be considered.
- Strong understanding of healthcare claims adjudication, appeals, payer processes, reimbursement methodologies, and performance metrics.
- Demonstrated analytical, problem-solving, communication, and leadership skills with the ability to use data to drive operational and financial improvements.
- Must have Salesforce or XiFin experience
Preferred Qualifications- Experience within laboratory, diagnostic, oncology, or other complex healthcare reimbursement environments.
- Experience working with commercial, Medicare, Medicaid, Medicare Advantage, and other government or managed care payers.
- Experience with revenue cycle analytics, dashboards, reporting tools, workflow automation, and process improvement.
- Knowledge of CPT/HCPCS coding, payer medical policies, timely filing requirements, and appeal processes.
AI & Digital Fluency
- Demonstrate curiosity, sound judgment, and the ability to critically evaluate and responsibly leverage AI-enabled tools in accordance with company policies, ethical standards, and regulatory requirements to improve the efficiency, effectiveness, and quality of work.
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 - Open Position (USA)
Primary Location Base Pay Range: $94,200 - $129,500
Other US Location(s) Base Pay Range: $80,070 - $110,075
If the role is performed in Colorado, the pay range for this job is: $84,780 - $116,550
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.
