United States » Field Reimbursement Manager

Field Reimbursement Manager

Home-based / Marlborough, MA, US.

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

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 Benefits Verification and Pre-Authorization Center aka the “Reimbursement Hotline” located in Valencia, California.
  • The Field Reimbursement Manager will be involved in 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.
  • Build relationships with provider staff and provide exceptional customer service.
  • Works as a liaison with the account, sales, and reimbursement hotline to provide information required to complete timely benefit verifications.
  • Completes metrics and trainings assigned by the Director of HEMA.
  • Follows HIPAA policies and procedures to ensure protected health information is secure and not accessible to employees not authorized to view the information.
  • Content development for tools and resources relative to the role.
  • 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 Benefits Verification 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 accounts receivable issues.
  • Provides the most effective communication to health plans to ensure maximum level of reimbursement approval.
  • The position will NOT provide any sales activity related to identifying potential patients, reimbursement guidance for any product/service not related to Boston Scientific or any practice that violates HIPAA.
  • May have budget responsibilities.

Required qualifications: 

  • 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 (e.g., CMS OPPS, IPPS, PFS annual rules).
  • Familiar with global market access requirements.
  • Demonstrated ability to work and influence in a matrix organization.
  • 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.
  • Ability to interact with medical and advocacy societies for enhancing patient access to BSC Urology portfolio of products.
  • Computer literacy (Microsoft Office Suite)
  • Domestic travel estimated at 30%, including overnight travel.

Preferred qualifications:

  • Experience working in a field sales support role and interactions with a reimbursement hotline or HUB to provide benefits verification support.
  • Urology industry experience is a plus
  • Experience with new technology reimbursement pathways, particularly device.
  • Ability to work with business development (BD) to assess reimbursement and access opportunities for targeted products.

Requisition ID: 537723

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.

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.

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 is posted by Boston Scientific.

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