Additional locations: (n/a); us-ca-los angeles; us-ca-san diego; us-ga-atlanta; us-il-chicago; us-ma-boston; us-ny-new york city; us-tx-dallas; us-tx-houston
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 challengesWith access to the latest tools, information and training, we’ll help you in advancing your skills and careerHere, you’ll be supported in progressing – whatever your ambitions.
About the role:
The senior manager, national payer contracting is a member of the endoscopy division’s health economics & market access teamHe/she is responsible for working collaboratively with endoscopy’s pathology franchise leadership team in developing and executing the national pathology payer contracting strategyThis position plays a critical role in supporting the growth of the pathology franchise through strategic partnerships with insurance companiesHis/her primary role is to proactively seek out targeted insurance companies, evaluate contractual arrangements, negotiate/renegotiate favorable fee schedule reimbursement and collaborate with internal departments to secure a finalized contract resulting in an “in-network” designation for boston scientific pathologyThis 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 franchiseThis position will manage and coordinate all insurance contracting efforts in compliance with the company vision, policies, procedures and goals.
Location: position can be remotePrefer major city (los angeles, san diego, boston, new york city, chicago, houston, dallas, atlanta)
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.
Develop and provide regular communications to internal departments to reflect the progress of payer 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.
Requisition id: 497028
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 lifeOur 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 operateNow 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 personalAnd 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 healthThat is why we stand for inclusion, equality, and opportunity for allBy 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 serveBoston scientific is proud to be an equal opportunity and affirmative action employer.
Boston scientific maintains a drug-free workplacePursuant to vaCode § 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: boston
Job segment: pathology, gastroenterology, medical, manager, accounts receivable, healthcare, management, finance
