Pre-Authorization Specialist II

Additional Locations: N/A

Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance

At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of diverse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing – whatever your ambitions.

About the role:
The Pre-Authorization Specialist is responsible for performing advanced benefit verifications and obtaining pre-authorization approvals from insurance carriers. This hybrid or remote role will support therapies within Neuromodulation Division.

Your responsibilities will include:

• 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
• Performs benefit verification, pre-surgical authorization for new pre-surgical cases, and appeals by working closely with all payers
• Coordinates with leadership regarding complicated cases
• Provides competitive levels of support to the functions of the internal team, Health Care Professional offices, and BSC sales representatives
• Suggests continuous process improvements
• Answers incoming calls received through the toll-free Pre-Authorization Support ACD and provides appropriate call/case handling
• Communicates and builds relationships with HCP offices and sales representatives regarding all inquiries for the handling of cases, i.e., missing case information, benefits etc.
• Notifies the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/adverse event notifications
• Maintains current metric standards
• Utilizes proficient knowledge in Microsoft Office and database management to document case status, actions, and outcome

Required qualifications:

• Excellent customer service skills; communicates clearly and effectively
• Experience working with various payors including, Medicare, Medicaid, Private Payor, and Workers Compensation as it relates to medical procedures, services, and devices
• Understanding of ICD-10, CPT, HCPCS coding and payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Experience building effective relationships with internal and external customers
• Minimum 1-year Insurance Pre-Authorization experience
• High School Diploma
• Proficient in MS Word, Excel

Preferred qualifications:

• Bachelor’s Degree
• Medical device experience
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

The anticipated hourly base pay range for this full-time position working at this location will be from $17.45 to $29.65, plus variable compensation from time to time (e.g., any overtime and shift differential) and annual bonus target (subject to plan eligibility and other requirements) and the value of core and optional employee benefits being offered at Boston Scientific (BSC), which can be reviewed at www.bscbenefitsconnect.com. At BSC, it is not typical for an individual to be hired near the bottom or top of the anticipated pay range. BSC considers various factors in determining actual compensation for this position at the expected location. Actual compensation will be commensurate with demonstrable level of experience and training, pertinent education including licensure and certifications, and other relevant business or organizational needs. Actual compensation may be otherwise adjusted if the position is filled outside of the intended geographic location.

Requisition ID: 562729

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most – united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do – as a global business and as a global corporate citizen.

So, choosing a career with Boston Scientific (NYSE: BSX) isn’t just business, it’s personal. And if you’re a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!