AMVETS Jobs

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