Field Reimbursement Manager I

Location

Marlborough, MA | United States

Job description

Additional Location(s): US-PA-Philadelphia; US-DE-Delaware; US-MD-Baltimore; US-NJ-Central; US-NJ-Northern; US-NJ-Southern; US-PA-Pittsburgh

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:
We are currently hiring for a Field Reimbursement Manager (FRM) to support our UROLOGY division. The ideal candidate will work closely with the field sales organization in an assigned territory providing billing, coding, coverage, and reimbursement support to physician offices, hospital outpatient and ambulatory surgery centers.  

This is a remote role at Boston Scientific.  Preferred location is Mid Atlantic area (PA, NJ, DE, MD, DC, VA and WV) and near a major airport. Domestic travel estimated at 30%, including overnight travel.

Your responsibilities will include:

• Key responsibilities entail conducting reimbursement training and billing education for new accounts and existing accounts identified by the Territory Manager and Regional Sales Manager.
• The Field Reimbursement Manager is a direct conduit to Boston Scientific’s Urology Procedure Access Program located in Valencia, California. 
• Communicating Medicare’s rule making process for IPPS, OPPS, and MPFS to the field per the guidance and direction of the HEMA Director.
• Account Maintenance: After initial education of the account, regular follow-up with the account is conducted either virtually, 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.
• Interacts with local and regional payers, including Medicare and Medicaid, as necessary to provide information about the procedure to support positive coverage and reimbursement.
• Conducts reimbursement reviews with customers by examining paid EOB’s, billing reports, or information provided by the practice to confirm the practice is billing Boston Scientific codes appropriately and being reimbursed accordingly. 
• Works as a liaison with the account, sales, and Urology Procedure Access Program team to provide information required to complete timely benefit verifications.
• 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 Urology Procedure Access Program team.
• Reports reimbursement trends and global concerns to management to ensure corrective actions and mitigation of future occurrences.
• Troubleshoots national and local payer reimbursement and policy issues.  
• Provides the most effective communication to health plans to ensure maximum level of reimbursement approval.

Required qualifications: 

• Bachelor’s degree in economics, finance, marketing, business, public health, or related field.
• 4+ years of experience as a field reimbursement manager, health economics, healthcare administration, health services research or similar discipline.
• 8+ years of experience in the medical industry, including medical device, pharmaceutical, or biotechnology companies.
• Strong understanding of coding, coverage, payment, and reimbursement methodologies in the US health care policy and payment systems, including ambulatory surgery center, hospital outpatient, and physician reimbursement. 
• Hands on experience with Federal rule making processes 
• Familiar with global market access requirements.
• Proficiency in presenting evidence and tools in a simplified manner to commercial organizations such as Sales and Marketing. This includes but not limited to sales education and training, medical education, and national accounts.
• Computer literacy (Microsoft Office Suite)

Preferred qualifications:

• Experience working in a field sales support role and interactions with a benefit verification/prior authorization case management team or HUB to provide benefits verification support. 
• Urology industry experience is a plus
• Ability to interact with medical and advocacy societies for enhancing patient access to BSC Urology portfolio of products.
• Experience with new technology reimbursement pathways, particularly device. 
• Ability to work with business development (BD) to assess reimbursement and access opportunities for targeted products. 
• Demonstrated ability to work and influence in a matrix organization. 

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Salary