Hybrid Reimbursement QA & Order Review Specialist

C20 Cochlear Americas (USA); Lone Tree (IA); Hybrid; USD 77,366,000 - 85,962,000; Full time

Job summary

Cochlear Americas seeks an experienced QA reviewer to ensure reimbursement orders are accurate, compliant, and ready for shipment and billing. You will verify coverage details, eligibility, and payor requirements while mitigating non-payment risk.

Collaboration with cross-functional teams is essential to drive improvements and maintain regulatory standards. The role emphasizes understanding Medicare/Medicaid guidelines, HIPAA compliance, and thorough order reviews in a hybrid office environment

Qualifications

• High school diploma or GED is required.
• 1+ year working with compliance regulations (HIPAA and CMS) relevant to medical billing.
• 2-3 years actively using Microsoft Excel with attention to spreadsheet details.

Responsibilities

• Review reimbursement billing orders prior to shipment for accuracy and compliance.
• Ensure payor requirements are met to support clean claims billed correctly.
• Identify process gaps and coach team members in coordination with QA managers.
• Document coaching opportunities and communicate issues to supervisors.
• Collaborate with leaders to implement process improvements maintaining QA thresholds.
• Follow federal/state/local coverage, Medicare/Medicaid guidelines, and payor billing rules.

Skills

Compliance regulations

Medicare & Medicaid knowledge

Excel proficiency

Education

High school diploma or GED

Tools

Microsoft Excel

Job description

Cochlear Americas seeks an experienced QA reviewer to ensure reimbursement orders are accurate, compliant, and ready for shipment and billing. You will verify coverage details, eligibility, and payor requirements while mitigating non-payment risk.

Collaboration with cross-functional teams is essential to drive improvements and maintain regulatory standards. The role emphasizes understanding Medicare/Medicaid guidelines, HIPAA compliance, and thorough order reviews in a hybrid office environment