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At Boston Scientific, you will find a collaborative culture driven by a passion for innovation that keeps us connected on the most essential level. With determination, imagination and a deep caring for human life, we're solving some of the most important healthcare industry challenges. Together, we're one global team committed to making a difference in people's lives around the world. This is a place where you can find a career with meaningful purposeimproving lives through your life's work.
About the role:
The Reimbursement Manager provides billing and coding education to customers and supports the Intrauterine Health (IUH) Sales Representative in the assigned territory. The position follows all necessary policies, procedures, processes and systems in place to support the maximum and most efficient reimbursement for the Boston Scientific (BSC) Cytuity device and procedure.
Your responsibilities include:
The field reimbursement position conducts training and education for new accounts and existing accounts identified by the Sales Representative and the hotline. Education consists of insurance benefit completion and process, billing and coding of BSC products and utilizes additional resources available through the Health Economics & Market Access team.
After initial education of the account, regular follow-up with the account is conducted either via phone or in person to ensure proper coding and claims submission of BSC products, identify any reimbursement issues and work with the account to resolve until appropriate payment is received.
Communicate procedures for physician office, ambulatory surgery center, and/or outpatient facility billers to implement a process to ensure maximum efficiency and collection of their accounts receivable, including coding procedures and processes for denial and low payment appeals.
Interacts with local and regional payers as necessary to provide information about the Cytuity procedure to support positive coverage and reimbursement.
Monitors receivables and collections data as available to provide detailed analysis of accounts receivable to physician billing functions.
Build relationships with provider staff and provide exceptional customer service.
Works as a liaison with the account, sales and reimbursement hotline to provide information required to complete timely benefit verifications.
Completes daily reports as assigned.
Follows HIPAA policies and procedures to ensure protected health information is secure and not accessible to employees not authorized to view the information.
Adheres to the organization's appeal strategy and manages the on-going tactical application of the appeal strategy to ensure a successful reversal rate in conjunction with the Reimbursement Hotline.
Reports reimbursement trends and global concerns to management to ensure corrective actions and mitigation of future occurrences.
Troubleshoots national and local payer reimbursement and accounts receivable issues.
Provides the most effective communication to health plans to ensure maximum level of reimbursement approval.
The position will NOT provide any sales activity related to identifying potential patients, reimbursement guidance for any product/service not related to Cytuity and/or any practice that violates HIPAA.
What we're looking for:
Bachelor's degree (preferably in health science or business area)
3-5 Years of experience in coding, coverage and reimbursement including insurance verifications, appeals submissions and resolution, billing/claims processing, data processing, and software operations in the health care industry
Requires a comprehensive understanding of Medicare, commercial and Medicaid payers, knowledge of medical coding including ICD-10 and CPT codes. AAPC certification a plus.
Ability to review medical records and verify patient medical criteria as cases are worked.
Ability to successfully interact with all levels of management, both internal and external, third party payers, and customers is essential.
Excellent communication and organizational skills are required for this position.
Comprehensive understanding of medical management and health insurance concepts, information systems and strong analytical and problem-solving skills are required.
Demonstrated work experience applying PC-based analytic tools to provide support to a health insurance or clinical process is required. (Excel, Word)
Ability to travel up to 50%
As a global medical technology leader for more than 35 years, our mission at Boston Scientific (NYSE: BSX) is to transform lives through innovative medical solutions that improve the health of patients. If you're looking to truly make a difference to people both around the world and around the corner, there's no better place to make it happen.
Boston Scientific is an Equal Opportunity Employer Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Disability, Veteran
Requisition ID: 443734