Reimbursement Operations PreClaim Specialist (Prior Authorization 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 support cochlear implant clinics and recipients, we are recruiting for a Reimbursement Operations PreClaim Specialist. We work in a collaborative work environment, have an opportunity to develop our knowledge and grow professionally and offer a competitive salary and benefits.
In alignment with our organizational principle of providing a safe work environment, and in order to comply with new requirements for contractors of the Federal Government, all US-based employees of Cochlear Americas are required to be fully vaccinated against COVID-19. The only allowable exceptions include qualifying medical and religious accommodations.
To be successful in this role, you will facilitate all pre-claim activity for reimbursement orders while providing exceptional service to internal and external customers. You will act with a sense of urgency to address inquiries while demonstrating a high degree of knowledge, integrity, and empathy in all aspects of team performance and operations.
As a subject matter expert in your respective region and insurance plans, you will identify solutions while maintaining positive relationships with customers. You’ll work collaboratively with Billing and Collections, Customer Experience and other operations teams to provide the most efficient order process for our recipients.
- Location: Lone Tree, CO at our Americas Head Office
- Comprehensive Training Classes approximately 3 weeks long and include classroom and hands-on instruction
- Schedule: This full-time position requires flexibility to work an eight-hour shift between 6:00 a.m. and 6:00 p.m., Monday through Friday. In order to best serve our customers, occasional overtime may be required.
- Obtain the necessary documentation needed to progress orders taken by the reimbursement operations team and obtain insurance authorization on equipment ordered.
- Review and evaluate all documentation (Letter of Medical Necessity, Certificate of Medical Necessity, Assignment of Benefits, Insurance Intake Forms, etc.)
- Perform Benefits Investigations, understand In/Out of Network Benefits and how they relate to co-insurance and deductibles due.
- Communicate out of pocket cost estimates to recipients.
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:
- Bachelors or Equivalent Work Experience
- 2-3 years of experience ideally working with health insurance, including but not limited to:
- Insurance Verification
- Prior Authorization
- Coordination of Benefits
- Out of Pocket cost estimate calculations
- Excellent computer skills (preferably in Microsoft Office) and experience utilizing common office resources (phone, fax, copier and email).
- Excellent verbal and written communication skills
- Must be detail oriented and able to meet deadlines
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 employee is regularly required to be in a stationary (seated/standing) position; utilizes 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.
While performing the duties of this job, the employee is regularly required to utilize comprehension, critical thinking, communication, problem solving, organization reasoning, relating to others and discernment of items such as product specifications, procedures and processes to customers (whether internal or external).
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
This role offers a hybrid work environment with a combination of in-office and work from home. We will consider candidates for 100% remote work as long as they reside in the state of Colorado (outside of the Denver metro area), Nevada, Idaho, Texas and Florida.
In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits:
Target Salary Rate for this position: $21.50/hr - $22.12/hr, as well as an annual bonus opportunity of 5% of base salary.
The overall benefit program includes medical, dental, vision, life and disability, pet insurance, Employee Stock Purchase Plan, 401K Matching, PTO (vacation, holidays, floating holidays, sick and volunteer time off), tuition reimbursement, maternity and paternity leave, and wellness programs.
More about Cochlear
Human needs have always been our inspiration, ever since Professor Graeme Clark set out to create the first multi-channel cochlear implant because he saw his father struggle with hearing loss. We always start with people in mind – thinking about their needs.
For this reason, our products, services and support will continue to evolve and improve. We are by our customers’ side through the entire hearing journey, so they can experience a life full of hearing. Our employees tell us that the number one reason they enjoy working for Cochlear is the opportunity to make a difference to people’s lives and working in an organization where they can be part of bringing the mission to life each day.
Visit our careers site at www.cochlear.us/careers to learn more about current openings! Apply now by completing your application form online. Applicants must meet the job specific application criteria to be considered.
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.