Reimbursement Pre-authorization Specialist Ii

7 days ago

Marlborough, Massachusetts, United States Boston Scientific Corporation Full time

Work mode:
Remote in Country
Onsite Location(s):Marlborough, MA, US, 01752
Additional Location(s): Remote
Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance

  • At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams of diverse and highperforming employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we'll help you in advancing your skills and career. Here, you'll be supported in progressing whatever your ambitions.

About the role:

The Reimbursement Pre-Authorization Specialist II is responsible for performing proficient benefit verification and pre-authorization functions with insurance carriers, within an established time frame, for new pre-surgical cases submitted to the Pre-Authorization Support Department

Your responsibilities will include:

  • Checking the departmental electronic inbox to coordinate the initial intake of physician and facility requests to secure prior authorization for service
  • Create electronic folders for new patients
  • Organize patient medical records in preparation for prior authorization and appeals process
  • Answers incoming calls received through the tollfree Pre-Authorization Support ACD and provides appropriate call/case handling
  • Performs benefit verification, presurgical authorization for new presurgical cases, and appeals by working closely with all payers
  • Utilizes proficient knowledge in Microsoft Office and database management to document case status, actions, and outcome
  • Communicates and builds relationships with HCP offices and Field Reimbursement Managers in regard to all inquiries for the handling of cases, i.e., missing case information, benefits etc.
  • Utilizes customer service skills in engaging with customers, communicating with sales representatives, and working in teams in a call center environment to expedite processing of cases
  • Coordinates with lead and supervisor regarding complicated cases

Required qualifications:

  • High School Diploma
  • Minimum 3year Insurance Pre-Authorization Reimbursement experience
  • Experience working with various payors including, Medicare, Medicaid and Private Payor, as it relates to medical procedures, services, and devices
  • Experience building effective relationships with internal and external customers
  • Exposure and working knowledge within Salesforce

Preferred qualifications:

  • Associate's Degree
  • Able to accurately document and communicate issues
  • Medical Device or Pharmaceutical background
  • Prior or current Boston Scientific experience within reimbursement

Requisition ID:

At Boston Scientific, we recognize that nurturing a diverse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health.

That is why we stand for inclusion, equality, and opportunity for all.

By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve.

Boston Scientific is proud to be an equal opportunity and affirmative action employer.- Boston Scientific maintains a prohibited substance free workplace.

Pursuant to Va.

Code , Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.

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Nearest Major Market:Boston

Job Segment:
Pharmaceutical, Call Center, Medical Device, Medicare, Medicaid, Science, Customer Service, Healthcare

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