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National Payer Contracting Manager (HEMA) Job

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Date: Feb 10, 2019

Location: Alpharetta, GA, US, 30009

Company: Boston Scientific

Additional Locations: (n/a); US-MA-Marlborough



Purpose and Passion • Comprehensive Benefits • Life-Work Integration • Community • Career Growth

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 purpose—improving lives through your life’s work.


About the role:


The National Payer Contracting Manager plays a critical role in building the pathology business through building strategic healthcare plan partnerships and provider contracting. The primary role of the National Payer Contracting Manager is to proactively seek out identified managed care companies and work to get Boston Scientific Pathology signed as an in-network provider.  This role requires coordination with the Billing, Contracting and Legal departments in order to execute contracting opportunities for the business. This position will manage and coordinate all managed care/payer contracting in compliance with the company vision, policies, procedures and goals.

Location: Alpharetta GA or Marlborough MA


Your responsibilities include: 

  • Lead the development and execution of the health plan contracting strategy.
  • Identify new payer contracting opportunities by analyzing revenue data and working closely with internal teams.
  • Secure new payer contracts, including managing applications and negotiations.
  • Coordinate new contract implementation and support successful contract execution.
  • Provide contract updates to internal teams and assist with training, as needed, to ensure appropriate staff has a thorough understanding of contract terms.
  • Work with internal team to ensure compliance with all payer contract requirements with regards to licensing, credentialing, company business licenses and any other requirements as defined in payer contracts.
  • Work with internal team to analyze all third party payer contracts including fee schedule changes, utilization trends, costs, estimated and realized revenues and profitability.
  • Assist internal teams with escalated claims issues involving payer contract interpretation, as needed.
  • Support internal team with any payer audit requests, as needed.



What we're looking for: 

Basic Qualifications: 

  • Minimum 3-5 years of successful direct payer contract negotiation experience required. 
  • Bachelor’s degree 
  • Knowledge of insurance markets, payer contracting, insurance verification, pre-authorization processes and billing and accounts receivable practices.
  • Ability to travel at least 25%


Preferred Qualifications:

  • At least 5 years of medical and/or healthcare selling experience.   
  • Pathology/Lab contracting experience.
  • Experience in healthcare revenue cycle management and medical billing.
  • Proficient in MS Word, Excel, PowerPoint and Outlook
  • Strong strategic selling and negotiating skills.
  • Problem solver with strong analytic skills.
  • Outstanding communications and interpersonal skills including developing relationships with health plans.
  • Strong self-starter with the ability to manage multiple tasks and meet deadlines with minimal supervision.
  • Exceptional team player.


About us

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


Requisition ID: 424632


Nearest Major Market: Alpharetta
Nearest Secondary Market: Atlanta

Job Segment: Pathology, Medical, Accounts Receivable, Medical Technology, Manager, Healthcare, Finance, Management