Boston Scientific Customer Billing III 

United States, Texas, Houston 

783675938

About the role:

• Perspective 1: Internal Contract Performance Review

This function assesses contractual terms, conditions, and/or regulatory requirements along with payer policy, identified operational requirements, and billing data to establish full operational compliance within the billing and collecting process.

• Perspective 2: This function assesses volumes of claim outcomes to ensure contractual terms, conditions, and/or regulatory requirements were performed by payers as necessary to pay covered services.

The process to perform under perspective 1 includes a summery overview of claim outcomes to determine if a default audit becomes a prerequisite to payer engagement. Default audits are in-depth reviews of claim volumes (attachment A) as necessary to review internal operational processes to ensure internal operational integrity and compliance to billing and payer requirements Default audits are equally required to prepare evidence of internal operational compliance as necessary to prepare evidence for payer presentations under perspective 2.
The process to perform under perspective 2 includes acquiring internal documents demonstrating full compliance when perspective 1 is not in default as well as outcome documentation to be used as evidence in payer presentations.

Your responsibilities will include:

• Monitors assigned payers for high-level performance reviews (assist in manually creating scorecards pending automation).
• Produces and circulates payer analytical outcome data to appropriate teams.
• Performs in-depth audits of payer requested challenges to RCM Leadership, HEMA/contracting.
• Performs formally assigned payer performance reviews under perspectives 1 & 2
• Performs formally assigned non-contracted payer performance reviews to support contracting efforts.
• Performs audits of payer policy directives and RCM instructions.
• Performs regulatory audits as required and/or as assigned by RCM, HEMA, legal and/or privacy.
• Supports RCM and HEMA staff on CERT audits as assigned.
• Supports high-volume data requests from insurers as assigned by RCM or HEMA leaders on behalf of contract administration and RCM.
• Supports other payer/data projects as assigned.

Required qualifications:

• 3 Years with Associate in Arts degree/diploma, or an equivalent combination of education/work experience
• Proficient use of all Microsoft Office applications and internal tools is required.
• Familiarity with Microsoft Dynamics and Xifin RPM Billing Platform.
• Ability to manage, sort and assess large data reports to summarize requested analytics.
• Extensive knowledge of health care claims and basic regulatory billing requirements.
• Basic knowledge of CPT and ICD-10 coding.
• Basic knowledge of Claim-by-claim Medical Appeals Processing.
• Understanding of and compliance with SOP’s listed herein.
• Proven ability to identify trends and apply critical thinking skills.
• Ability to work independently to meet provided timelines.

Among other requirements, Boston Scientific maintains specific prohibited substance testing requirements for safety-sensitive positions. This role is deemed safety-sensitive and, as such, candidates will be subject to a drug test as a pre-employment requirement. The goal of the drug testing is to increase workplace safety in compliance with the applicable law.

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.