Boston Scientific

Patient Access Case Manager

Boston Scientific • $62K — $119K *
Marlborough, MA 01752In-Person
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • 2+ years in pain management or spine prior authorization role, including clinical record review for medical necessity
  • Experienced in submitting prior authorization requests for medical procedures
  • Proficient in interpreting procedure denials and drafting appeals
  • Understanding of payer coverage criteria to ensure positive outcomes
  • 2+ years of experience utilizing software systems for task execution

Responsibilities

  • Follow up on prior authorization requests to ensure review for medical necessity
  • Apply pressure on health plans for coverage policy reviews
  • Identify payer denial reasons and develop appeal action plans
  • Draft appeal letters and documents for hearings
  • Monitor payer engagement until final determination is reached
  • Participate in hearings as a representative for Medicare Advantage patients
  • Communicate effectively with internal and external customers about case statuses

Benefits

  • Remote work model available
  • Flexible work hours primarily within Eastern Time Zone
  • Opportunity to work closely with healthcare professionals
  • Engage in meaningful work that directly impacts patient care
  • Potential for professional development and team collaboration
Full Job Description
Additional Location(s): N/A

About the role:

The Patient Access Case Manager is responsible for managing the patient case through the insurance authorization and appeal process. This position will work closely with Interventional Spine team members and external customers (physicians and patients) to identify and overcome obstacles in the patient access program and reimbursement environment.

Work model, sponsorship, relocation:
This role follows a remote work model. Qualified candidates from any location in the United States will be considered. Primary support is expected to be within Eastern Time Zone. Boston Scientific will not offer sponsorship or take over sponsorship of an employment visa for this position at this time. Relocation assistance is not available for this position at this time.

Your responsibilities will include:
  • Follow up on prior authorization requests to health plans to ensure receipt and proper review for medical necessity.
  • Apply pressure on health plans that refuse to review based on negative or absent coverage policy for Intracept.
  • Accurately identify payer denial reasons and develop an action plan for appeal.
  • Draft letters for appeal, external review, and administrative law judge hearings.
  • Monitor and re-engage payer until final determination is made - ensuring each available level of appeal is used and all appeal rights are exhausted.
  • Participate in administrative law judge hearings via phone, presenting on behalf of the Medicare Advantage patient.
  • Submit prior authorization requests to health plan as needed to assist the team achieving identified goals and objectives.
  • Draft all case related communication to physicians, patients and payers in a clear and concise manner.
  • Document all case activity and correspondence for cases in a timely and accurate manner to provide chronological details of case progress.
  • Confirm accuracy of authorization approval details, ensuring all codes are captured and authorization is within approved timeframes prior to surgery.
  • Manage and monitor payer trends as it relates to approvals/denials and communicate trends to the team.
  • Clearly communicate with internal and external customers regarding patient access to Intracept Procedure, including but not limited to (case status, needed information, TM involvement, reporting etc.).
  • Act as a resource for fellow team members and new employees.
  • Prioritize tasks according to urgency:
    • Expected Total case volume 140-160


Required qualifications:
  • 2+ years of experience in a pain management or spine prior authorization role. Experience must include:
    • Reviewing clinical records and extracting key information to support medical necessity
    • Submitting prior authorization requests for medical procedures
    • Interpreting procedure denials and drafting appeals
    • Understanding and leveraging payer coverage criteria to ensure positive outcomes
  • 2+ years of experience utilizing software systems to perform tasks


Preferred qualifications:
  • Neuromodulation or Basivertebral nerve ablation experience
  • Ability to communicate clearly and assertively with payers
  • Strong written and verbal communication skills
  • Software experience, i.e. EMR, payer portals, Microsoft Office, Salesforce


Requisition ID: 629985

Minimum Salary: $62800

Maximum Salary: $119300

The anticipated compensation listed above and the value of core and optional employee benefits offered by Boston Scientific (BSC) - see www.bscbenefitsconnect.com-will vary based on actual location of the position and other pertinent factors considered in determining actual compensation for the role. Compensation will be commensurate with demonstrable level of experience and training, pertinent education including licensure and certifications, among other relevant business or organizational needs. At BSC, it is not typical for an individual to be hired near the bottom or top of the anticipated salary range listed above.

Compensation for non-exempt (hourly), non-sales roles may also include variable compensation from time to time (e.g., any overtime and shift differential) and annual bonus target (subject to plan eligibility and other requirements).

Compensation for exempt, non-sales roles may also include variable compensation, i.e., annual bonus target and long-term incentives (subject to plan eligibility and other requirements).

For MA positions: It is unlawful to require or administer a lie detector test for employment. Violators are subject to criminal penalties and civil liability.

About Boston Scientific

BTG offers program solutions for small business programs, management workforce development, emerging business growth strategies, training development and delivery strategies, and business planning services.

Boston Scientific Careers

Joining Boston Scientific means becoming part of a global team dedicated to advancing science for life. With a focus on medical solutions that improve the health of patients around the world, Boston Scientific offers unparalleled job opportunities in the healthcare industry. Work You’ll Do At Boston Scientific, your work contributes directly to transforming lives through innovative medical solutions. As a member of our team, you will collaborate with skilled professionals to drive growth and innovation in healthcare. Our commitment to leadership in the industry makes Boston Scientific a place where careers flourish and professional development is taken seriously. Boston Scientific Leadership and Development Programs We are committed to nurturing a culture of growth and leadership. Boston Scientific’s development programs are designed to foster professional skills, leadership qualities, and a deep understanding of the medical devices industry. Whether you’re just starting out with an internship or you’re a seasoned professional, our programs help you achieve your career ambitions. Innovative Work Join a team where innovation is at the heart of everything we do. Boston Scientific is a leader in developing cutting-edge technologies and solutions that address unmet patient needs. By focusing on innovation, we maintain our leadership in the medical field and ensure continuous growth and improvement. Be Part of a Diverse and Inclusive Team At Boston Scientific, we believe that diversity fuels innovation. Our commitment to diversity and inclusion is evident in our hiring practices and the dynamic team culture we cultivate. Employees from various backgrounds bring unique perspectives that lead to better solutions and a more inclusive workplace. Benefits and Opportunities Boston Scientific is dedicated to providing employees with competitive benefits and a supportive environment that values health and well-being. Our benefits package includes comprehensive health coverage, retirement plans, and employee wellness programs, all designed to support your life both inside and outside of work. Explore Career Opportunities Whether you’re looking for an internship, a full-time position, or a leadership role, Boston Scientific offers a range of career paths. Explore job opportunities that match your skills and interests on our Careers page. We are always looking for curious, creative, and driven individuals to join our team. Stay Connected Keep up to date with the latest at Boston Scientific by following our Careers Blog. Gain insights from our team, learn about our culture, and get tips on everything from crafting your resume to acing your interview. Networking and Professional Growth Enhance your career through networking opportunities within Boston Scientific. Connect with leaders, gain industry insights, and build relationships that will help propel your career forward. Our professional environment encourages networking and collaboration, which are key to personal and professional growth. Join Our Team Search open positions at Boston Scientific that align with your skills and interests. We are looking for passionate, innovative, and solution-driven team players ready to make a difference. Start your journey with us today and be part of a company that’s dedicated to transforming lives through science. SEARCH BOSTON SCIENTIFIC JOBS Job Alert Emails Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding career opportunities that await at Boston Scientific.
Learn more about Boston Scientific
Size
41,000 employees
Market Cap
$66.3 billion
Industry
Healthcare
Net Income
-$82 million
Founded
1979
5 Year Trend
+7.2%
Revenue
$9.9 billion
NASDAQ
BSX
* Ladders Estimates

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