Pre-Authorization Specialist II at Boston Scientific Corporation Malaysia

Georgetown, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Jan, 26

Salary

0.0

Posted On

25 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Insurance Verification, Prior Authorization, Appeals Processing, Customer Service, Microsoft Office, Salesforce, Communication, Clinical Records Review, Payer Coverage Criteria, HIPAA Compliance, Data Integrity, Continuous Improvement, Case Handling, High-Volume Work, Problem Solving

Industry

Medical Equipment Manufacturing

Description

Verify medical insurance benefits and coverage, including the ability to obtain and process payer forms Submit prior authorization/pre-determination requests, and internal and external appeals to health plans to assist the team in achieving identified goals and objectives Apply pressure on health plans that refuse to review based on negative or absent coverage policy for Endobariatric procedures (i.e., Endoscopic Sleeve Gastroplasty, Transoral Outlet Reduction Endoscopy) Follow up on prior authorization and appeal requests to health plans to ensure receipt and proper review for medical necessity Monitor and re-engage payer until final determination is made, ensuring each available level of appeal is used and all appeal rights are exhausted Answer incoming calls received through the toll-free PASP call center, providing superior customer service and appropriate call/case handling Utilize proficient knowledge in Microsoft Office and Salesforce to document case statuses, actions, and outcomes in a timely and accurate manner Effectively communicate and build relationships with HCP office and internal stakeholders regarding all inquiries and handling of cases Maintain PASP metrics and standards Process incoming emails by responding and triaging inquiries in an appropriate manner. Process incoming faxes to efficiently manage service requests and facilitate communication from customers, patients, and payers as appropriate Report adverse events/product complaints following program Standard Operating Procedures (SOPs) Comply with SOPs to maintain data integrity Maintain HIPAA compliance and patient confidentiality Engage and commit to the organization's culture of continuous improvement by actively participating, supporting, and promoting BSC Mission and Values Consistently provide superior quality and service in a high-volume work environment Coordinate with lead regarding complicated cases Other duties as assigned High school diploma Minimum 2-years' relevant experience including: Working with various payers including, Medicare, Medicaid, Private/Commercial, and VA Reviewing clinical records and extracting key information to support medical necessity Submitting prior authorization requests for medical procedures Understanding and leveraging payer coverage criteria to ensure positive outcomes Proficient in Microsoft Office Excellent written and verbal communication skills Ability to work independently with minimal to moderate supervision Travel

Responsibilities

The Pre-Authorization Specialist II is responsible for verifying medical insurance benefits and submitting prior authorization requests. They will also follow up on requests and ensure compliance with health plan requirements.