Reimbursement QA: Order Review Specialist

cochlear; Lone Tree (CO); Hybrid; USD 37,000 - 41,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life and disability insurance

401(k) matching

Paid time off

Tuition reimbursement

Maternity and paternity leave

Employee Stock Purchase Plan

Pet insurance

Annual bonus

Job summary

Cochlear in Lone Tree, CO is seeking a Reimbursement Quality Assurance Order Review Specialist to audit reimbursement billing orders, ensure accuracy, and mitigate non-payment risk across payer guidelines.

This hybrid role collaborates with Customer Service, Reimbursement Operations, Finance and Supply Chain to ensure timely order review and compliant processing from order review through shipping and collections.

Qualifications

• High school diploma or GED required.
• 1+ year working with compliance regulations in medical billing (HIPAA and CMS), Medicaid and Medicare reimbursements.
• 2–3 years of actively using Microsoft Excel with emphasis on spreadsheet details.

Responsibilities

• Review all Reimbursement Billing Services Orders prior to shipment to ensure accuracy, completion, and compliance requirements.
• Follow the order review process to meet payor requirements and ensure clean claim billing on first submission.
• Identify, monitor and coach process gaps in order fulfillment in coordination with the Insurance Service Accreditation and Quality Manager.
• Understand and apply federal, state, and local coverage, Medicare and Medicaid guidelines in order reviews.
• Verify eligibility and covered benefits, including active policy dates, prior authorizations, OTAs, COBs, co-insurance, and reimbursement according to contracts.

Skills

Insurance & authorizations

Attention to detail

Education

High School Diploma or GED

Tools

Microsoft Excel

Job description

Cochlear in Lone Tree, CO is seeking a Reimbursement Quality Assurance Order Review Specialist to audit reimbursement billing orders, ensure accuracy, and mitigate non-payment risk across payer guidelines.

This hybrid role collaborates with Customer Service, Reimbursement Operations, Finance and Supply Chain to ensure timely order review and compliant processing from order review through shipping and collections.