Patient Access Case Manager

Boston Scientific•Arden Hills, MN

1d•$57,100 - $108,500•Remote

About The Position

The Patient Access Case Manager manages patient cases through the insurance authorization and appeal process. The role works closely with Interventional Spine team members and external customers, including physicians and patients, to identify and overcome obstacles in the patient access program and reimbursement environment. The position supports access to the Intracept Procedure and manages case communications, documentation, payer follow-up, and authorization details. Expected total case volume is 140–160. This is a remote role requiring consistent working-hour alignment with the normal business hours of the assigned market. Boston Scientific does not offer employment visa sponsorship or relocation assistance for this position.

Requirements

At least 2 years of experience in a pain management or spine prior authorization role, including reviewing clinical records and extracting key information to support medical necessity.
At least 2 years of experience in a pain management or spine prior authorization role, including submitting prior authorization requests for medical procedures.
At least 2 years of experience in a pain management or spine prior authorization role, including interpreting procedure denials and drafting appeals.
At least 2 years of experience in a pain management or spine prior authorization role, including understanding and leveraging payer coverage criteria to ensure positive outcomes.
At least 2 years of experience utilizing software systems to perform tasks.

Nice To Haves

Neuromodulation or basivertebral nerve ablation experience.
Ability to communicate clearly and assertively with payers.
Strong written and verbal communication skills.
Experience with software such as EMR systems, payer portals, Microsoft Office, and Salesforce.

Responsibilities

Follow up on prior authorization requests to health plans to ensure receipt and proper review for medical necessity.
Press health plans to review requests when they refuse based on a negative or absent coverage policy for Intracept.
Identify payer denial reasons and develop an action plan for appeal.
Draft letters for appeals, external reviews, and administrative law judge hearings.
Monitor and re-engage payers until a final determination is made, ensuring each available appeal level is used and appeal rights are exhausted.
Participate by phone in administrative law judge hearings, presenting on behalf of Medicare Advantage patients.
Submit prior authorization requests to health plans as needed to help the team achieve identified goals and objectives.
Draft clear and concise case-related communications to physicians, patients, and payers.
Document case activity and correspondence accurately and promptly, providing chronological details of case progress.
Confirm authorization approval details, including that all codes are captured and authorization is within approved timeframes before surgery.
Monitor payer approval and denial trends and communicate trends to the team.
Communicate with internal and external customers about access to the Intracept Procedure, including case status, needed information, TM involvement, and reporting.
Act as a resource for fellow team members and new employees.
Prioritize tasks according to urgency.