Shire Veteran Jobs

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

Prior Authorization Specialist (Internal title: Reimbursement Operations PreClaim Specialist)

• Application deadline: September 27, 2024

Change people's lives and love what you do! Cochlear is helping people hear, and be heard, all over the world and is the most recognized brand in hearing health care.

About the role

If you have a passion for working with health insurance providers and are looking for an opportunity to develop your knowledge and grow professionally, this is a fantastic opportunity to join the Reimbursement Operations team at the global leader in implantable hearing devices! In this role, you will be based in our Americas head office based 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.

Your success in this role is measured by your ability to facilitate all pre-claim activity for reimbursement orders while providing exceptional service to internal and external customers. Work collaboratively with your peers within a region setting where you will develop subject matter expertise, as well as with internal stakeholders in Billing and Collections, Customer Experience and other operations teams to provide the most efficient order process for our recipients.

Key Responsibilities

• Verify eligibility, investigate insurance benefits and validate coverage; calculate and collect recipient out-of-pocket estimates based on their deductible, coinsurance and out-of-pocket maximum
• Collect documentation based on payor requirements and medical professional preferred method
• Evaluate medical documentation for accuracy, requirements and validity and submit to insurance for prior authorization when required
• Manage first-level appeals in response to prior authorization denials
• Communicate professionally, effectively and clearly with customers to ensure understanding and meet the customer need
• Secure in-network exceptions and negotiate one-time agreements with insurance payors in which Cochlear is nonparticipating
• Engage with cross-functional business partners to support reimbursement processes, orders and customers

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:

• 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

• Proven ability to work collaboratively and positively in a team environment to build strong, professional relationships

• Excellent computer skills (preferably in Microsoft Office) and experience utilizing common office resources (phone, fax, copier and email).
• Excellent verbal and written communication skills

Salary and Benefits

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

• Target Salary Range/Rate: $23.50 - $25.00 per hour based upon experience, as well as an annual bonus opportunity of 5% of base salary. Compensation offered to candidate may vary based on work experience, education and/or skill level.
• 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 - thinkin 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