Job Details

Pre Authorization Specialist I

The Pre-Authorization Specialist I 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 a remote work model.

Relocation

Relocation assistance is not available for this position at this time.

VISA

Boston Scientific will not offer sponsorship or take over sponsorship of an employment VISA for this position at this time.

Your responsibilities include:

• 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.
• Review and understand payer denials, determining appropriate next step according to payer appeal guidelines and internal BSC process.
• Utilizes proficient knowledge in Microsoft Office and database management to document case status, actions, and outcome.
• Communicates and builds relationships with HCP offices and sales representatives in regards to 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.
• 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.
• Maintains current metric standards.
• Provides competitive levels of support to the functions of the internal team, Health Care Professional offices, and BSC sales representatives.
• Suggests continuous process improvements.
• Coordinates with lead and supervisor with regard to complicated cases.

Required qualifications:

• High School Diploma or equivalent
• Minimum 2-years authorizing medical procedures/surgeries with commercial, Medicare, Medicare Advantage, and worker's comp payers. (pain management/spine preferred)
• Minimum 1-year claim appeal experience (preferred).

Work Requirements:

• Secure home office space with ability to protect HIPAA sensitive materials.
• Designated workspace that is free from distractions.
• Home office desk, and chair.
• Reliable high-speed internet connection

Compensation will be commensurate with demonstrable level of experience and training, pertinent education including licensure and certifications, among other relevant business or organizational needs.