Reimbursement Quality Assurance Order Review Specialist

Cochlear•Lone Tree, CO

1d•Hybrid

About The Position

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.

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

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.