Reimbursement Quality Assurance 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

About the role

Change people’s lives and love what you do at Cochlear—the most recognized brand in hearing health care—helping people hear and be heard around the world, while being part of one of Denver Business Journal’s 2026 Best Places to Work honorees in Denver. This position will be responsible for upholding the highest level of quality assurance in accurately reviewing product and service orders. This role ensures the highest mitigation of the risk of order non-payment and compliance with all state and federal regulations and laws as orders transition from order review to shipping and billing and collections. Working collaboratively with Customer Service, Reimbursement Operations, Finance, Reimbursement Billing and Recipient Account Collections, Reimbursement Order Review, and Supply Chain team members, this role also ensures timely completion of all reimbursement order reviews. 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 3 days per week minimum, with 2 days per week working from home.

Key Responsibilities

• Review all Reimbursement Billing Services Orders prior to shipment to ensure accuracy, completion, and compliance requirements are met.
• Responsible for following the order review process to ensure that all payor requirements have been met before orders are released to ensure a clean claim billed the first time and to mitigate the risk of non-payment; including understanding Cochlear’s warranty policy and reviewing all orders to ensure that no orders are billed to insurance where the item is still under warranty.
• Responsible for identifying, monitoring, escalating, and solutioning process gaps in the order fulfillment process and issues requiring coaching of team members that are found during the Reimbursement Order Review process in coordination with the Insurance Service Accreditation and Quality Manager.
• Document and communicate to relevant supervisors and managers coaching opportunities and issues identified.
• Partner with leaders to implement improvements to process with quality assurance advisements that ensure specified coaching needs are directed effectively to improve overall performance and efficiency aligned with quality assurance thresholds and performance targets.
• Responsible for understanding and following federal, state, and local agency coverage, Medicare and Medicaid guidelines, payor specific billing guidelines and regulations and using this understanding as a baseline for all order reviews.
• Responsible for eligibility verification and understanding of covered benefits by plan, including active policy coverage dates, Prior-authorizations, OTAs, COBs, co-insurance payments, and expected reimbursement according to applicable fee schedules, contracts, and billing guide stipulations and requirements.

Key Requirements

• High school diploma or GED
• 1+ year(s) working with compliance regulations associated with medical billing (HIPAA and CMS guidelines), experienced with Medicaid and Medicare reimbursement processes and procedures, ability to check DME orders for completeness and compliance with state, federal and local laws
• 2-3 years of actively using Microsoft Excel with an emphasis on understanding spreadsheet details

Total Rewards

In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits. Pay Range in the United States: $27.00/hr - $30.00/hr based upon experience, as well as an annual bonus opportunity of 5% of base salary. Exact compensation may vary based on skills, experience, and location. 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 – thinking 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 that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the individual is regularly required to be in a stationary (seated/standing) position; utilize business technology for work product delivery, communicate orally and in writing with others internal or external to the organization, utilize problem solving/critical thinking skills to discern and convey information. May be asked to occasionally transport/move up to 30 pounds, depending on the position. Specific vision abilities required by this job include ability to adjust focus. The individual is regularly required to utilize comprehension, critical thinking, communication, problem solving, organization reasoning, relating to others and discernment of items such as product specifications, procedures and processes to customers (whether internal or external). Influence, organization/classification of information and planning are also required. The work environment is a home/office environment. This is representative of the environment an individual may encounter while performing the essential functions of this job.

Equal Opportunity Employer

Cochlear Americas is an Equal Opportunity Employer. We will provide reasonable accommodations for qualified individuals with disabilities. If you require accommodation with completing the online application, please contact us via web or phone at 303-264-2549.

Application Deadline

Deadline to apply by October 12, 2026.

Company Culture

Our growth is creating great opportunities! Our team is expanding and we want to hire the most talented people we can. Continued success depends on it. So once you've had a chance to explore our current open positions, apply to the ones you feel suit you best and keep track of both your progress in the selection process, and new postings that might interest you! We’re the global leader in implantable hearing solutions. We have provided more than 600,000 implantable devices, helping people of all ages to lead full and active lives. We help people hear and be heard. We empower people to connect with others and live a full life. We help transform the way people understand and treat hearing loss. We innovate and bring to market a range of implantable hearing solutions that deliver a lifetime of hearing outcomes.