Boston Scientific Pre-Authorization Specialist II 

United States 

780994921

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 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
• 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 3-year 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
• Able to accurately document and communicate issues
• Experience building effective relationships with internal and external customers

Preferred qualifications:

• Associate’s Degree
• Medical Device or Pharmaceutical background
• Exposure and working knowledge within Salesforce

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.