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 f
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
rd-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
ass
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
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