Principal Reimbursement Analyst

Additional Locations: 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:
By leveraging your clinical expertise and attention to detail, the Principal Reimbursement Analyst will play a critical role in improving patient access to the Neuromodulation therapies they need to improve their quality of life. This role will support the Neuromodulation division’s Spinal Cord Stimulation (SCS) and Vertiflex (IS) therapies. The position is based in Valencia, California, but remote candidates will be considered.

Your responsibilities will include:

• Providing utilization review and addressing apparent data gaps based upon coverage approval criteria commonly used by commercial and Medicare+Advantage plans in their determination of benefits available to insured,
• Effecting compliant, timely and complete reporting to internal and external stakeholders,
• Collecting, organizing and ensuring timely communication of patient-identifiable information between the prescribing and treating physician, patient, Boston Scientific Reimbursement Operations staff and contractors engaged within the prior authorization and appeals process,
• Reviewing medical records, administrative documents and agreements to ensure complete information is available for use by the patient, prescriber and contractors engaged to represent beneficiaries in their pursuit of prior authorization and successful appeal,
• Identifying and pursuing data you believe may be missing from the patient and/or physician; and work with Boston Scientific staff and third parties should further information, medical records or administrative requirements be required.
• Conducting reviews of case files, and identifying systemic issues, data gaps or trends which, if corrected, would likely result in timely access to indicated care and implantation of the SCS or VertiFlex devices as prescribed and indicated for clinical use,
• Organizing data and assisting with program reporting, metrics and case-specific outcomes as directed by Boston Scientific Reimbursement Operations staff,
• Minimal travel to Boston Scientific locations and physician customers offices may be required.

Required qualifications:

• RN, LPN or equivalent degree
• 5+ years practicing experience as a licensed nurse
• 5+ years’ experience in utilization review
• Experience working within spine surgery and/or interventional pain management
• Knowledge of medical terminology and procedures

Preferred qualifications:

• Strong verbal and written communication skills
• Strong capabilities working with information systems and applications
• Case Management, Care Management, Condition Management and/or Disease Management experience
• MCG Certification

The anticipated annualized base pay range this full-time position working at this location will be from [$121,000 to $230,100], plus variable compensation, i.e., annual bonus target (subject to plan eligibility and other requirements) and the value of core and optional employee benefits being offered at Boston Scientific (BSC), which can be reviewed at www.bscbenefitsconnect.com. At BSC, it is not typical for an individual to be hired near the bottom or top of the pay range. BSC considers various factors in determining actual compensation for this position at the expected location. Actual compensation will be commensurate with demonstrable level of experience and training, pertinent education including licensure and certifications, and other relevant business or organizational needs. Actual compensation may be otherwise adjusted if the position is filled outside of the intended geographic location.

Requisition ID: 562666

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!

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