Job Description:

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



Reimbursement QA & Documentation Specialist



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



About the role



Cochlear is helping people hear, and be heard, all over the world. Come be a part of our amazing mission! If you know reimbursement and quality assurance, this is a fantastic opportunity to join the team at the global leader in implantable hearing devices! In this role, you will be based in our Americas head office in Lone Tree, CO. This role is hybrid, requiring you to be in the office 2 days per week minimum, with 3 days per week working from home.


The Reimbursement Quality Audit & Documentation Specialist will work closely with the Reimbursement QA Supervisor to perform quality assurance activities with the focus on monitoring and improving reimbursement collection efforts. The primary function of this position will be to perform audits on various functions within the Reimbursement Billing and Collections Teams to ensure the highest levels of quality exists within daily operations in adherence to standard procedure expectations. In conjunction, the QA Documentation Specialist will be responsible for SOP and WI creation and maintenance in coordination with the Reimbursement QA Supervisor and business stakeholders. The QA will be responsible for ensuring all team members have the necessary training, tools and materials needed to perform in their roles and will keep staff informed of any procedural changes or enhancements to the QA process. Additionally, the QA specialist will be responsible for timely facilitation of third-party audits.



Key Responsibilities



Perform Monthly Reimbursement QA Audits - Monitor, audit, analyze, and report on Reimbursement Claim Cycle/Invoice/billing and collections activity and trends, including Inbound/Outbound Calls and all other applicable forms of reimbursement and patient communications for Billing and Collections Teams. Monitor and follow-up on Reimbursement QA Team email, fax, and postal mail communications in accordance with procedures.


Ensure Reimbursement QA's Audit Cycle prep for Order Audit, Claim Cycle/Billing and Collections, miscellaneous audit requests (training/onboarding audits, special audits, etc.), and QA analysis/reporting/scorecard completion and delivery are maintained in a timely manner at the required daily, weekly, and monthly intervals. This includes support, and assistance with regular and consistent completion of all responsibilities in adherence with upholding required levels of quality assurance.


Responsible for identifying, monitoring, escalating, and solutioning process gaps in the order fulfillment/claim cycle/billing and collections process and issues requiring coaching of team members that are found during the Reimbursement QA Audit process in coordination with the Reimbursement QA Supervisor. Document and communicate to relevant supervisors and managers coaching opportunities and issues identified. Partner with leaders to implement improvements to process with QA advisements that ensure specified coaching needs are directed effectively to improve overall performance and efficiency aligned with Quality Assurance thresholds and performance targets.


Monitoring, supporting, and ensuring reimbursement teams' adherence to federal, state, and local agency coverage, Medicare and Medicaid guidelines, payor specific billing guidelines and regulations through order/claim/billing and collections QA reviews. Additionally, this includes eligibility verification, understanding of covered benefits by plan, active policy coverage dates, Prior-authorizations, OTAs, COBs, Out-of-pocket estimates, co-insurance/deductible payments, and expected reimbursement according to applicable fee schedules, contracts, and billing guide stipulations and requirements.


Complete third party payer audits including owning the review, research, submission, and follow-up of payer audits directed towards Cochlear's reimbursement department. Coordinate with all internal departments impacted by a third- party audit to gather supporting documentation to comply with the audit request; to include shipment/delivery details, prior authorization, and supporting medical documentation. Communicate audit details with department leadership and working with our provider relations specialist to ensure the audit is responded to timely, tracked, and reported on monthly.


Create and maintain SOP and Work Instruction including process improvement revisions and facilitation of document management in Cochlear's QMS (Quality Management System) Master Control. This role will work with HR and the Reimb. QA Supervisor and supported team's leadership to ensure all team members have the necessary training, tools and materials needed to sufficiently perform the duties of their roles. This includes keeping teams informed of any procedural changes or enhancements to their respective reimbursement and QA processes.



Key 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:

• Bachelor's Degree with 2-3 Years of Experience Or High School Diploma/GED with 6+ Years of Experience


• DME Medical billing/collections experience and/or QA/Bill Review experience, working with payors and/or working knowledge of the DME reimbursement process; must include actively using DME Medical Billing Terminology including HCPCs codes.


• 1+ year(s) working with compliance regulations associated with medical billing (HIPAA and CMS guidelines), Experienced with Medicaid and Medicare reimbursement processes and procedures, Ability to check orders/claims for completion and compliance with federal, state and local laws


• Experience working in a QA environment involving a high attention to detail; Strong critical/analytical thinking skills. Experience in quality improvement and analysis


• Experience analyzing and diagnosing process gaps in order to collaborate with leadership to effect change/Process improvement within the organization


• 2-3+ years of actively using Microsoft Excel with an emphasis on understanding spreadsheet details.


• Experience and proven track record of consistency/reliability with upholding responsibilities for critical business functions and deliverables with deadlines/set timelines in like roles, assignments, and or projects

Total Rewards



In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits.

• Pay Range in the United States: $27.00 - $29.00 based upon experience, as well as an annual bonus opportunity of 5% of base salary. Exact compensation may vary based on skills, experience, and location.


• Benefit package includes medical, dental, vision, life and disability insurance as well as 401(K) matching with immediate vesting, Paid Time Off, tuition reimbursement, maternity and paternity leave, Employee Stock Purchase Plan and pet insurance.

Who are we?



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.



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. May be asked to occasionally transport/move up to 30 pounds, depending on the position. Specific vision abilities required by this job include ability to adjust focus. The individual 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). Influence, organization/classification of information and planning are also required.


The work environment is a hybrid home/office environment and represents those an individual may encounter while performing the essential functions of this job.



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. Apply Now