Additional Location(s): N/A
Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance
At Boston Scientific, we offer opportunities to work with diverse, high-performing teams on important health industry challenges. We support your career growth with access to the latest tools, information, and training, fostering your development and ambitions.
About the role:
The Pre-Authorization Specialist II is responsible for benefit verification, prior authorization, and appeals within the Patient Access Support Program (PASP). The role involves collaborating with PASP team members, internal and external customers, and payers to secure insurance approval for endobariatric procedures using Boston Scientific devices.
Your responsibilities will include:
1. Verify medical insurance benefits and coverage, including processing payer forms.
2. Submit prior authorization/pre-determination requests and appeals to health plans.
3. Follow up on authorization and appeal requests to ensure proper review and final determination.
4. Draft appeal letters for internal and external submissions.
5. Monitor and re-engage payers until final decisions are made, exhausting all appeal rights.
6. Handle incoming calls via the PASP call center, providing excellent customer service.
7. Use Microsoft Office and Salesforce to document case details accurately and promptly.
8. Build effective relationships with healthcare providers and staff.
9. Maintain PASP metrics and standards.
10. Manage email and fax queues for inquiries and requests.
11. Report adverse events and product complaints following SOPs.
12. Ensure compliance with HIPAA and patient confidentiality standards.
13. Participate in continuous improvement initiatives aligned with BSC Mission and Values.
14. Provide high-quality service in a high-volume environment.
15. Coordinate with leads on complex cases.
16. Perform other duties as assigned.
Minimum qualifications:
* High school diploma.
* At least 2 years of relevant experience, including:
o Working with payers such as Medicare, Medicaid, Private Commercial, and VA.
o Reviewing clinical records to support medical necessity.
o Submitting prior authorization requests for procedures.
o Understanding payer coverage criteria.
o Proficiency in Microsoft Office.
o Excellent communication skills.
o Ability to work independently.
o Travel up to 5%.
Preferred qualifications:
* Associate’s degree.
* Experience with medical devices or bariatrics.
* Experience with Salesforce, EMR, payer portals, or Policy Reporter.
* Experience interpreting denials and drafting appeals.
Requisition ID: 605629
Salary Range: $39,624 - $67,392
Compensation varies based on location, experience, education, and organizational needs. Boston Scientific is committed to equal opportunity employment and prohibits discrimination based on protected classes.
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