Home-based / Marlborough, MA, US.
The Senior Field HEMA Manager is a field-based role, providing services to customers as it relates to coding, coverage, and reimbursement. This role maintains expertise in billing, coding and coverage supporting Urology technologies for all businesses. The position follows all necessary policies, procedures, processes, and systems in place to support the maximum and most efficient reimbursement for BSC Urology products. This position serves as an advisory role and supports projects related to business development, investigational devices, analytic reporting, CMS rulings and policy, commercial payer policy development and creation of educational documentation for HEMA department and field use. This role advises HEMA on potential reimbursement opportunities within the US payer systems including government, Centers for Medicare and Medicaid and US Commercial payers.
This is a field-based, remote position at Boston Scientific.
Your responsibilities will include:
- The field-based position conducts training and education for FRMs on pertinent issues and changes within the payer systems.
- Supports FRM team as a point of escalation for specific account needs and complex issues.
- Aligns with CMS efforts and data analytics to support knowledge and decision-making efforts as it applies to our technologies.
- Consults with HEMA department on internal projects.
- Leads efforts on specific projects to address reimbursement related outcomes for the advancement of BSC technologies.
- Designs HEMA collateral for customer and field education use.
- Presentations for physician education at courses and/or conferences; as well as develops reimbursement review concepts for physician offices, LUGPAs, hospitals, or ASCs.
- 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.
- Collaborates with functional colleagues to inform strategic activities related to health economic research, health policy and business development.
- Support senior leadership to ensure health economics and reimbursement data are incorporated into product development/business strategies and timelines
- Completes all other job duties as assigned.
Minimum qualifications
- Bachelor’s degree in economics, finance, marketing, business, public health, or related field and at least 10 years of professional experience.
- 8+ years of experience in coding, coverage and reimbursement including insurance verifications, appeals submissions and resolution, billing/claims processing, data processing, and software operations in the health care industry.
- Knowledge of Urology technologies and surgical interventions.
- Comprehensive understanding of Medicare, Medicaid and commercial payer policy.
- Knowledge of medical coding including ICD-10 and CPT codes.
- Knowledge and experience with proposed and final CMS annual ruling.
- Demonstrates work experience applying PC-based analytic tools to provide support to a health insurance or clinical process (Excel, Word, etc.)
- Ability to travel up to 50%
Preferred qualifications:
- AAPC certification preferred
- Ability to successfully interact with all levels of management, both internal and external, third-party payers, and customers.
- Excellent communication and organizational skills.
- Comprehensive understanding of medical management and health insurance concepts, information systems and strong analytical and problem-solving skills.
Requisition ID: 596740
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 Corporation has been and will continue to be an equal opportunity employer. To ensure full implementation of its equal employment policy, the Company will continue to take steps to assure that recruitment, hiring, assignment, promotion, compensation, and all other personnel decisions are made and administered without regard to race, religion, color, national origin, citizenship, sex, sexual orientation, gender identify, gender expression, veteran’s status, age, mental or physical disability, genetic information or any other protected class.
Boston Scientific maintains a prohibited substance 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.
Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.
This job ad will be unpublished on 11/01/2025.
This job is posted by Boston Scientific.
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