Patient Access Case Manager

Additional Location(s): N/A

Diversity - Innovation - Caring - Global Collaboration - Winning Spirit- High Performance

At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams of diverse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we'll help you in advancing your skills and career. Here, you'll be supported in progressing - whatever your ambitions.

About the role:
As a Patient Access Case Manager supporting the Interventional Spine business, you will play a critical role in navigating patients through the insurance authorization and appeals process. You will work closely with internal team members as well as physicians and patients to identify and resolve barriers to access, ensuring timely and successful reimbursement. Your expertise will help patients receive the care they need while supporting Boston Scientific's mission to transform lives through innovative medical solutions.

This role follows a remote work mode. Qualified candidates from any location in the United States will be considered.

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

Your responsibilities will include:

• Following up on prior authorization requests to ensure receipt and appropriate review by health plans
• Applying pressure to health plans that decline reviews based on negative or missing coverage policies for Intracept
• Accurately identifying denial reasons and developing effective appeal strategies
• Drafting appeal letters, external reviews, and documentation for administrative law judge hearings
• Monitoring case status and re-engaging payers until a final determination is made, exhausting all appeal rights
• Representing Medicare Advantage patients during administrative law judge hearings via phone
• Submitting prior authorization requests as needed to support team goals
• Drafting clear and professional communication to physicians, patients, and payers
• Maintaining accurate, detailed case documentation to support case progression
• Verifying authorization approvals to ensure all procedure codes and timeframes are captured prior to surgery
• Monitoring and analyzing payer trends related to approvals and denials, sharing insights with the team
• Clearly communicating case updates, required information, and next steps with internal and external stakeholders
• Acting as a resource for teammates and onboarding new employees
• Prioritizing tasks based on urgency and case volume (expected total case volume: 140-160)

Required qualifications:

• 2+ years' experience in a pain management or spine-related prior authorization role, including:
• Reviewing clinical records to support medical necessity
• Submitting prior authorization requests for medical procedures
• Interpreting denials and drafting appeals
• Applying payer coverage criteria to achieve favorable outcomes
• 2+ years' experience working within software systems to complete core responsibilities
• Ability to travel less than 5%
• Ability to work a 40-hour week
• Ability to sit/stand at a workstation for up to 8 hours per day
• High school diploma

Preferred qualifications:

• Experience with neuromodulation or basivertebral nerve ablation procedures
• Strong verbal and written communication skills, including assertive communication with payers
• Familiarity with software systems such as EMRs, payer portals, Microsoft Office, and Salesforce

Requisition ID:

Minimum Salary: $58200

Maximum Salary: $

The anticipated compensation listed above and the value of core and optional employee benefits offered by Boston Scientific (BSC) - see 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.

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most - united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do - as a global business and as a global corporate citizen.

So, choosing a career with Boston Scientific (NYSE: BSX) isn't just business, it's personal. And if you're a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!

At Boston Scientific, we recognize that nurturing a diverse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health. That is why we stand for inclusion, equality, and opportunity for all. By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve.

Boston Scientific Corporation has been and will continue to be an equal opportunity employer. To ensure full implementation of its equal employment policy, the Company will continue to take steps to assure that recruitment, hiring, assignment, promotion, compensation, and all other personnel decisions are made and administered without regard to race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, gender expression, veteran status, age, mental or physical disability, genetic information or any other protected class.

Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company's policies or protocols change with regard to COVID-19 vaccination.