Reimbursement Quality Assurance Order Review Specialist at Cochlear in Denver, Colorado

Job Description:

Reimbursement Quality Assurance Order Review Specialist

Change people's lives and love what you do! Cochlear is the most recognized brand in hearing health care.

About the role

In order to help Cochlear ensure excellence in the quality of order intake and reimbursement, we are recruiting for a Reimbursement Quality Assurance Order Review Specialist in our Americas head office based in Lone Tree, CO.

Position Overview

This position will be responsible for accurately auditing orders to be billed directly to insurance companies using Cochlear's reimbursement services before they are shipped to mitigate the risk of non-payment once the claim is billed to the insurance company while remaining in compliance with all state and federal regulations and laws.

To be successful in this role, you'll be able to provide the highest level of quality assurance through the review and completion of received product and service orders. You'll work collaboratively with cross-functional team members to ensure timely quality assurance reviews of all customer orders and systems entry completion.

In performance of the quality assurance reviews, timely and accurate order placement with accurate reimbursement information will be enforced, maintained, and successfully ensured. As a result, top efficiency and volumes of successful order fulfillment will be achieved, allowing for successful rates of timely and accurate reimbursement.

Essential Functions

• Review all Reimbursement Billing Services Orders prior to shipment to ensure accuracy, completion, and compliance requirements are met.


• Responsible for following the order review process to ensure that all payor requirements have been met before orders are released to ensure a clean claim billed.


• Identify process gaps in the order fulfillment process and issues requiring coaching of team members that are found during the order review process.


• Understand and follow federal and state agency coverage, Medicare and Medicaid guidelines, payor specific billing guidelines and regulations and using this understanding as a baseline for all order reviews.


• Responsible for eligibility verification and understanding of covered benefits by plan, including active policy coverage dates, Prior-authorizations, OTAs, COBs, co-insurance payments, and expected reimbursement according to applicable fee schedules, contracts, and billing guide stipulations and requirements.


• Responsible for timely completion of monthly Accreditation Chart Audits and reporting


• New hire training, coaching, and mentoring

Key Incumbent Requirements

To add value to Cochlear in this role you'll be able to meet and demonstrate the following knowledge, skills and abilities in your application and at interview.

Minimum:

• Bachelor's degree & 2-3 years of working experience OR High School Diploma/GED & 6 years of working experience.


• 2-3 years of Medical billing/collections experience and/or QA/Bill Review experience.


• Experienced with Medicaid and Medicare reimbursement processes and procedures.


• Self-motivated team player with a high attention to detail.


• Strong critical/analytical thinking skills.


• Proven track record of consistency/reliability with upholding responsibilities for critical business functions and deliverables in like roles, assignments, and or projects.

Ideal:

• Experience actively using Microsoft Excel with an emphasis on understanding spreadsheet details.


• Direct order audit review experience.

Physical & Mental Demands

The physical and mental demands described below are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the individual is regularly required to be in a stationary (seated/standing) position; utilize business technology for work product delivery, communicate orally and in writing with others internal or external to the organization, utilize problem solving/critical thinking skills to discern and convey information such as product specifications, procedures and processes.

The work environment is an open cubicle environment with noise levels that vary from mild to noisy. The employee must be able to work and interact in this type of environment.

Schedule

The work schedule for this position will fall between 7:00am-6:00pm, Monday through Friday. In order to best serve our customers, occasional overtime may be required. After six months of employment, employee may elect to work from home one day per week.

In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits. The Target Salary Range: $24.37-$25.00/hour as well as a bonus/incentive of 6% of base salary.

The overall benefit program includes medical, dental, vision, life and disability, pet insurance, 401K Matching, PTO (vacation, holidays, floating holidays, sick and volunteer time off), tuition reimbursement, transportation supplementation, maternity and paternity leave, and wellness programs.

Apply now by completing your application form online. Applicants must meet the job specific application criteria to be considered. Visit our careers site at www.cochlear.us/careers to learn more.

Cochlear Americas is an Equal Opportunity, Affirmative Action Employer and provides equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, marital status, veteran status, or any other characteristic protected by federal, state or local law. In addition, Cochlear will provide reasonable accommodations for qualified individuals with disabilities. If you require accommodation with completing the online application, please contact us via web or phone at 303-264-2549.