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Specialist II, Reimbursement Job

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Date: Sep 11, 2021

Location: Valencia, CA, US, 91355

Company: Boston Scientific

Additional Locations:


Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - Caring - 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 this role:
The Reimbursement Specialist II is responsible for performing the initial benefit verification and pre-authorization functions with insurance carriers, within an established time frame, for new pre-surgical cases submitted to the Reimbursement Services Department. The Reimbursement Specialist II is responsible for providing competitive levels of support to the internal team, Health Care Professional offices, and BSC sales representatives.
Your responsibilities includes:

  • Answers incoming calls received through the toll-free Pre-Authorization Support ACD and provides appropriate call/case handling
  • Performs benefit verification, pre-surgical authorization for new pre-surgical cases, and appeals by working closely with all payers
  • Utilizes proficient knowledge in Microsoft Office and database management to document case status, actions, and outcome 
  • Communicates and builds relationships with HCP offices and sales representatives in regards to all inquiries for the handling of cases, i.e., missing case information, benefits etc.
  • Notifies the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/adverse event notifications
  • Utilizes customer service skills in engaging with customers, communicating with sales representatives, and working in teams in a call center environment to expedite processing of cases
  • Maintains current metric standards
  • Provides competitive levels of support to the functions of the internal team, Health Care Professional offices, and BSC sales representatives
  • Suggests continuous process improvements
  • Coordinates with lead and supervisor with regard to complicated cases
  • Responsible for working with Reimbursement Services leadership to develop and generate key reporting metrices and for making Intake process improvement recommendations


Minimum Qualifications:

  • High School Diploma
  • Minimum 1-year Insurance Pre-Authorization Reimbursement experience
  • Experience working with various payors including, Medicare, Medicaid, Private Payor, and Workers Compensation as it relates to medical procedures, services, and devices
  • Able to accurately document and verbalize problems
  • Experience building effective relationships with internal and external customers
  • Call Center experience 
  • Proficient in MS Word, Excel


Preferred Qualifications:

  • Bachelor’s Degree
  • Medical device experience


Requisition ID: 496577


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 is proud to be an equal opportunity and affirmative action employer.


Boston Scientific maintains a drug-free workplace. Pursuant to Va. Code § 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.


Nearest Major Market: Los Angeles

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