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Boston Scientific · 1 month ago

Pre Authorization Specialist I

United States

Full-time

Remote

Entry Level

$36K/yr - $61K/yr

2+ years exp

Boston Scientific is a leader in medical science, committed to solving important health industry challenges. The Pre-Authorization Specialist I is responsible for performing benefit verification and pre-authorization functions with insurance carriers for new pre-surgical cases, while also providing customer service support and maintaining metric standards.

Health CareMedicalMedical Device

No H1B

Responsibilities

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

Qualification

Benefit verificationPre-authorizationClaim appeal experienceMicrosoft OfficeCustomer service skills

Required

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