Customer Billing III

Additional Location(s):  N/A

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: 
Boston Scientific Cardiac Diagnostic Services bills tens of thousands of health care claims to third party insurers nationally under hundreds of national and local provider contracts as well as non-contracted insurance entities.  The revenue quality , analytics and auditing function requires a dual perspective approach that must be performed in sequence and in a fashion that would support any downstream contractual or non-contractual legal considerations.  This function will be initiated by the RCM team with routine outcome assessments for new contracts as well as payers in default as assigned by HEMA

• Perspective 1: Internal Contract Performance Review

This function assesses contractual terms, conditions, and/or regulatory requirements along with payer policy, identified operational requirements, and billing data to establish full operational compliance within the billing and collecting process.

• Perspective 2:    This function assesses volumes of claim outcomes to ensure contractual terms, conditions, and/or regulatory requirements were performed by payers as necessary to pay covered services.

The process to perform under perspective 1 includes a summery overview of claim outcomes to determine if a default audit becomes a prerequisite to payer engagement.   Default audits are in-depth reviews of claim volumes (attachment A) as necessary to review internal operational processes to ensure internal operational integrity and compliance to billing and payer requirements   Default audits are equally required to prepare evidence of internal operational compliance as necessary to prepare evidence for payer presentations under perspective 2.  
The process to perform under perspective 2 includes acquiring internal documents demonstrating full compliance when perspective 1 is not in default as well as outcome documentation to be used as evidence in payer presentations.

 

Your responsibilities will include:

• Monitors assigned payers for high-level performance reviews (assist in manually creating scorecards pending automation).
• Produces and circulates payer analytical outcome data to appropriate teams.
• Performs in-depth audits of payer requested challenges to RCM Leadership,  HEMA/contracting.
• Performs formally assigned payer performance reviews under perspectives 1 & 2 
• Performs formally assigned non-contracted payer performance reviews to support contracting efforts.
• Performs audits of payer policy directives and RCM instructions.
• Performs regulatory audits as required and/or as assigned by RCM, HEMA, legal and/or privacy.
• Supports RCM and HEMA staff on CERT audits as assigned.
• Supports high-volume data requests from insurers as assigned by RCM or HEMA leaders on behalf of contract administration and RCM.
• Supports other payer/data projects as assigned.

 

Required qualifications:

• 3 Years with Associate in Arts degree/diploma, or an equivalent combination of education/work experience
• Proficient use of all Microsoft Office applications and internal tools is required.
• Familiarity with Microsoft Dynamics and Xifin RPM Billing Platform.
• Ability to manage, sort and assess large data reports to summarize requested analytics. 
• Extensive knowledge of health care claims and basic regulatory billing requirements.
• Basic knowledge of CPT and ICD-10 coding.
• Basic knowledge of Claim-by-claim Medical Appeals Processing.
• Understanding of and compliance with SOP’s listed herein.
• Proven ability to identify trends and apply critical thinking skills.
• Ability to work independently to meet provided timelines.

Requisition ID: 589024

Among other requirements, Boston Scientific maintains specific prohibited substance testing requirements for safety-sensitive positions.  This role is deemed safety-sensitive and, as such, candidates will be subject to a drug test as a pre-employment requirement.  The goal of the drug testing is to increase workplace safety in compliance with the applicable law.  

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 l