Pre-Authorization Specialist II

Boston Scientific • Marlborough, MA

36d • $39,624 - $67,392 • Remote

About The Position

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. Work Mode At Boston Scientific, we value collaboration and synergy. This role follows remote in country work model.

Requirements

• 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

Nice To Haves

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

Responsibilities

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Merchant Wholesalers, Durable Goods
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees