Reimbursement Coordinator II

Medtronic•USA-FL, FL

1d•$42,400 - $63,600•Remote

About The Position

At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You’ll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world. A Day in the Life As one of three comprehensive portfolios at Medtronic, Neuroscience is dedicated to improving the lives of people living with neurological disorders, spine conditions, and chronic pain. Guided by our Mission—to alleviate pain, restore health, and extend life—we develop technologies and therapies that help people regain function, reduce pain, and return to the activities that matter most. Our Neuromodulation operating unit delivers advanced therapies for chronic pain, movement disorders, and nervous system conditions, offering SCS, DBS, and targeted drug delivery. Through proven technology, clinical evidence, and innovation, we provide personalized solutions that restore function and enhance quality of life. Check us out on LinkedIn: Medtronic Brain Modulation and Pain Interventions The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. The representative will ensure patient insurance coverage and benefits, identify requirements for prior approval, and submit for authorization. Assists with appealing prior authorization denials, retro authorization, or other special cases At Medtronic, we bring bold ideas forward with speed and decisiveness to put patients first in everything we do. This position is remote to enhance our competitive edge and expand cross-functional collaboration. This role will require some travel to enhance collaboration and ensure the successful completion of projects.

Requirements

Requires full job knowledge of systems and procedures obtained through prior work experience or education.
Requires a minimum of 2 years of relevant experience.

Nice To Haves

AAPC Coding Certificate
College Degree
Sales Force User
Customer Service Experience

Responsibilities

Validates insurance patient’s coverage, communicates any issues with benefits or coverage to the appropriate managers
Checks the requirements for prior authorization and initiates as required
Coordinates required paperwork, clinical notes, and forms for submission to support requests and initiates as required
Follows up frequently to ensure visibility on authorization status throughout the approval process
Basic knowledge of the payer payment process, with detailed knowledge of the payer prior authorization process
Basic ICD9/10 and CPT code familiarity, expert knowledge on a subset of Medtronic therapy codes
Superior customer service skills with outstanding communication skills to use with various stakeholders: physicians, sales representatives, payer representatives, utilization reviewers, and various internal and external stakeholders.
Advanced Microsoft Excel skills. Ability to learn and use multiple CRM software programs as needed
Good organizational skills with the ability to handle multiple inquiries at the same time, and critical problem-solving skills with high attention to detail
Communicate with healthcare provider (HCP) office staff to clarify payer coverage requirements, confirm documentation needed for prior authorization submissions, and address questions related to medical policy criteria.
Monitor and interpret payer coverage policies and prior authorization requirements across Medicare, Medicaid, and commercial payers, serving as a subject matter resource on policy updates and coverage criteria that may impact authorization outcomes.
Develop and maintain working knowledge of reimbursement pathways, coding considerations, and payer coverage policies relevant to ENT devices in order to support accurate prior authorization submissions and resolve coverage-related inquiries.
Partner with field personnel to provide education, guidance, and ongoing support related to prior authorization processes, payer requirements, and reimbursement-related inquiries.
Support reporting activities by tracking prior authorization submissions, approval and denial trends, and payer policy changes to provide insights that inform reimbursement strategy and operational improvements.
Review prior authorization denials to identify root causes and conduct outreach to provider offices and payers to support reconsideration, resubmission, or appeal when appropriate.
Provide mentorship and training to new team members by sharing best practices, reimbursement knowledge, and guidance on prior authorization workflows and payer requirements.
Maintain and update prior authorization and reimbursement resources, including internal guidance documents, payer policy summaries, and process documentation to support team consistency and accuracy.
Support auditing and monitoring of program productivity by reviewing case activity, turnaround times, and authorization outcomes to help ensure operational effectiveness and process adherence.
Assist in addressing escalated prior authorization and reimbursement concerns by collaborating with internal teams, provider offices, and payers to facilitate resolution and support patient access.

Benefits

Health, Dental and vision insurance
Health Savings Account
Healthcare Flexible Spending Account
Life insurance
Long-term disability leave
Dependent daycare spending account
Tuition assistance/reimbursement
Simple Steps (global well-being program)
Incentive plans
401(k) plan plus employer contribution and match
Short-term disability
Paid time off
Paid holidays
Employee Stock Purchase Plan
Employee Assistance Program
Non-qualified Retirement Plan Supplement (subject to IRS earning minimums)
Capital Accumulation Plan (available to Vice Presidents and above, or subject to IRS earning minimums)