Reimbursement Coordinator II

We anticipate the application window for this opening will close on - 6 Jun 2026 At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You’ll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world.A Day in the Life                  Across our global Neuroscience organization, we advance care for some of medicine’s most complex neurological and spinal conditions. By combining innovative technology, data-driven insights, and deep clinical expertise, we partner with physicians and health systems to improve how patients are treated and supported throughout their care journey.Our Neuromodulation Operating Unit provides advanced therapies for chronic pain, movement disorders, and other neurological conditions. Through spinal cord stimulation, deep brain stimulation, and targeted drug delivery systems, we deliver personalized treatments that restore function, reduce symptoms, and improve quality of life worldwide.Check us out on LinkedIn: Medtronic Brain Modulation and Pain InterventionsThe Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. The representative will ensure patient insurance coverage and benefits, identify requirements for prior approval, and submit for authorization. Assists with appealing prior authorization denials, retro authorization, or other special cases.At Medtronic, we bring bold ideas forward with speed and decisiveness to put patients first in everything we do. This position is remote to enhance our competitive edge and expand cross-functional collaboration. This role will require some travel to enhance collaboration and ensure the successful completion of projects.Responsibilities Include, But Are Not Limited ToValidates insurance patient’s coverage, communicates any issues with benefits or coverage to the appropriate managers Checks the requirements for prior authorization and initiates as requiredCoordinates required paperwork, clinical notes, and forms for submission to support requests and initiates as requiredFollows up frequently to ensure visibility on authorization status throughout the approval process Basic knowledge of the payer payment process, with detailed knowledge of the payer prior authorization process Basic ICD9/10 and CPT code familiarity, expert knowledge on a subset of Medtronic therapy codesSuperior customer service skills with outstanding communication skills to use with various stakeholders: physicians, sales representatives, payer representatives, utilization reviewers, and various internal and external stakeholders. Advanced Microsoft Excel skills. Ability to learn and use multiple CRM software programs as neededGood organizational skills with the ability to handle multiple inquiries at the same time, and critical problem-solving skills with high attention to detailCommunicate with healthcare provider (HCP) office staff to clarify payer coverage requirements, confirm documentation needed for prior authorization submissions, and address questions related to medical policy criteria.Monitor and interpret payer coverage policies and prior authorization requirements across Medicare, Medicaid, and commercial payers, serving as a subject matter resource on policy updates and coverage criteria that may impact authorization outcomes.Develop and maintain working knowledge of reimbursement pathways, coding considerations, and payer coverage policies relevant to ENT devices in order to support accurate prior authorization submissions and resolve coverage-related inquiries.Partner with field personnel to provide education, guidance, and ongoing support related to prior authorization processes, payer requirements, and reimbursement-related inquiries.Support reporting activities by tracking prior authorization submissions, approval and denial trends, and payer policy changes to provide insights that inform reimbursement strategy and operational improvements. Review prior authorization denials to identify root causes and conduct outreach to provider offices and payers to support reconsideration, resubmission, or appeal when appropriate.Provide mentorship and training to new team members by sharing best practices, reimbursement knowledge, and guidance on prior authorization workflows and payer requirements. Maintain and update prior authorization and reimbursement resources, including internal guidance documents, payer policy summaries, and process documentation to support team consistency and accuracy.Support auditing and monitoring of program productivity by reviewing case activity, turnaround times, and authorization outcomes to help ensure operational effectiveness and process adherence.Assist in addressing escalated prior authorization and reimbursement concerns by collaborating with internal teams, provider offices, and payers to facilitate resolution and support patient access.Qualifications:Must Have: Minimum RequirementsMinimum of 2 years of relevant experienceNice to Have:AAPC Coding CertificateCollege DegreeSales Force UserCustomer Service ExperienceFor 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 RequirementsThe above statements are intended to describe the general nature and level of work being performed by employees assigned to this position, but they are not an exhaustive list of all the required responsibilities and skills of this position. The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilit