Boston Scientific Pre Authorization Specialist United States, California, Santa Clarita 763945975
About this role:
The Pre-Authorization Specialist I 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 include:
- Answers incoming calls received through the toll free Pre-Authorization Support ACD and provides appropriate call/case handling
- Performs benefit verification, pre-surgical authorization for new pre-surgical cases, and appeals by working closely with all payers
- Review and understand payer denials, determining appropriate next step according to payer appeal guidelines and internal BSC process.
- Utilizes proficient knowledge in Microsoft Office and database management to document case status, actions, and outcome
- Communicates and builds relationships with HCP offices and sales representatives in regards to all inquiries for the handling of cases, i.e., missing case information, benefits etc.
- Notifies the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/adverse event notifications
- 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
- Maintains current metric standards
- Provides competitive levels of support to the functions of the internal team, Health Care Professional offices, and BSC sales representatives
- Suggests continuous process improvements
- Coordinates with lead and supervisor with regard to complicated cases
Required qualifications:
- High School Diploma or equivalent
- Minimum 2-years authorizing medical procedures/surgeries with commercial, Medicare, Medicare Advantage, and worker’s comp payers. (pain management/spine preferred)
- Minimum 1-year claim appeal experience (preferred).
Work Requirements:
- Secure home office space with ability to protect HIPAA sensitive materials.
- Designated workspace that is free from distractions.
- Home office desk, and chair.
- Reliable high-speed internet connection
Compensation fornon-exempt (hourly), non-sales rolesmay also include variable compensation from time to time (e.g., any overtime and shift differential) and annual bonus target (subject to plan eligibility and other requirements).
Compensation forexempt, non-sales rolesmay also include variable compensation, i.e., annual bonus target and long-term incentives (subject to plan eligibility and other requirements).
For MA positions:It is unlawful to require or administer a lie detector test for employment. Violators are subject to criminal penalties and civil liability.
Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.
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