Reimbursement Coordinator II
About the role
A Day in the Life
The Neuromodulation Operating Unit partners with healthcare providers, patients, and payers to help ensure timely access to Medtronic therapies. The reimbursement and prior authorization function supports patient access by navigating payer requirements, coverage policies, and authorization workflows across Medicare, Medicaid, and commercial health plans.
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This is a remote position within the United States with no travel required. Team members collaborate virtually with provider offices, field-based partners, payer representatives, and internal stakeholders to support prior authorization and reimbursement activities.
This role is responsible for coordinating prior authorization activities to support patient access to Neuromodulation therapies. The Prior Authorization Representative works closely with healthcare provider offices, payers, field teams, and internal partners to verify insurance coverage, facilitate authorization submissions, monitor case progress, resolve reimbursement-related issues, and support coverage approvals.
Primary Responsibilities
- Verify patient insurance benefits, coverage eligibility, and prior authorization requirements.
- Initiate, submit, and track prior authorization requests with Medicare, Medicaid, and commercial payers.
- Coordinate collection and review of clinical documentation, medical records, coding information, and required forms to support authorization submissions.
- Monitor authorization status and proactively follow up with provider offices and payers to support timely coverage decisions.
- Analyze authorization denials and support reconsideration, resubmission, and appeal activities when appropriate.
- Interpret payer coverage policies, reimbursement requirements, and authorization criteria to support accurate submissions and case resolution.
- Partner with field personnel and healthcare provider offices to provide guidance on authorization processes, reimbursement pathways, and payer requirements.
- Maintain accurate case records, reporting data, and reimbursement resources while supporting operational audits, productivity monitoring, and process improvements.
Required Qualifications
- High School Diploma and 2+ years of experience in prior authorization, reimbursement, healthcare revenue cycle, payer operations, insurance verification, or patient access support.
- Experience working with Medicare, Medicaid, and commercial payer authorization processes.
- Experience reviewing and coordinating medical documentation for prior authorization submissions.
- Experience using Microsoft Excel and case management, customer relationship management (CRM), or healthcare workflow systems.
- Experience managing multiple cases simultaneously while meeting quality and turnaround requirements.
Preferred Qualifications
- Associate's or Bachelor's degree.
- American Academy of Professional Coders (AAPC) Coding Certification.
- Experience supporting medical device, neuromodulation, or healthcare reimbursement programs.
- Knowledge of ICD-10 and Current Procedural Terminology (CPT) coding.
- Experience using Salesforce and healthcare reimbursement or patient access platforms.
For Baccalaureate degrees earned outside of the United States, a degree that satisfies the requirements of 8 C.F.R. § 214.2(h)(4)(iii)(A) is required.
Physical Job Requirements
U.S. Work Authorization & Sponsorship
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Medtronic offers a competitive Salary and flexible Benefits Package
Not included in the source posting: about the role.
Skills
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