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Senior Manager, National Pathology Contract Manager Job

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Date: Jul 13, 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 Senior Manager, National Payer Contracting is a member of the Endoscopy division’s Health Economics & Market Access team.  He/she is responsible for working collaboratively with Endoscopy’s pathology franchise leadership team in developing and executing the national pathology payer contracting strategy.  This position plays a critical role in supporting the growth of the pathology franchise through strategic partnerships with insurance companies. His/her primary role is to proactively seek out targeted insurance companies, evaluate contractual arrangements, negotiate favorable fee schedule reimbursement and collaborate with internal departments to secure a finalized contract resulting in an “In-Network” designation for Boston Scientific Pathology.  This role requires coordination with multiple internal departments including Revenue Cycle Management, Finance, Legal, Marketing and Sales departments in order to properly execute contracting opportunities for the pathology franchise. This position will manage and coordinate all insurance contracting efforts in compliance with the company vision, policies, procedures and goals.

 

Location: Alpharetta GA or Marlborough MA

 

Your responsibilities include: 

  • Assess pathology contracting opportunities and challenges facing the business’ pathology franchise and communicate business impact to senior management.
  • Lead the development and execution of the national pathology payer contracting strategy by managing enrollment applications, coordinating credentialing activities, negotiating favorable fee schedule reimbursement and securing fully-executed contracts to support “In-Network” status.
  • Work with internal team to analyze all third-party payer contracts including fee schedule changes, utilization trends, costs, estimated and realized revenues.
  • Coordinate new contract implementation with Revenue Cycle Management team to support successful contract execution.
  • Collaborate with cross-functional teams in the development and communication of payer contracting activities and messaging to support pathology service growth.
  • Monitor policy developments that impact the reimbursement of pathology services.  Build relationships in key markets with government, physician, ambulatory surgery center and third-party decision makers. 
  • Develop and provide regular communications to internal departments to reflect the progress of payor contracting strategy and related efforts. 
  • Ensure compliance with all payer contract requirements with regards to licensing, credentialing, company business licenses and other requirements as defined in payer contracts.
  • Work with business development teams to ensure pathology payer contracting needs are incorporated into business development plans and timelines, as appropriate.
  • Assist internal teams with escalated claims issues involving payer contract interpretation and support payer audit requests, as needed.

 

 

What we're looking for: 

Basic Qualifications: 

  • Minimum 10 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.
  • Pathology/Lab contracting experience.
  • Experience in healthcare revenue cycle management and medical billing.
  • Ability to interpret and integrate business strategies into actionable, value-added Health Economics and Market Access planning initiatives.
  • Strong strategic selling and negotiating skills.
  • Strong self-starter with the ability to manage multiple tasks and meet deadlines with minimal supervision.
  • Problem solver with strong analytic skills.
  • Ability to travel at least 25%

 

Preferred Qualifications:

  • At least 5 years of medical and/or healthcare selling experience. 
  • Outstanding communications and interpersonal skills including demonstrated ability to develop relationships at all levels in the organization and with health plans.
  • Demonstrated ability to make effective decisions independently and to work in a fast-paced matrixed environment.
  • Proficient in MS Word, Excel, PowerPoint and Outlook.
  • 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: 444958

 


Nearest Major Market: Alpharetta
Nearest Secondary Market: Atlanta

Job Segment: Pathology, Gastroenterology, Medical, Medical Technology, Manager, Healthcare, Management