UNIV - Hearing Aid Reimbursement and Payer Relations Specialist - Department of Otolaryngology

Hearing Aid Reimbursement and Payer Relations Specialist - Department of Otolaryngology

The Hearing Aid Reimbursement and Payer Relations Specialist manages all aspects of hearing device reimbursement, payer policy oversight, and financial performance. This role verifies insurance benefits, interprets coverage policies, supports prior authorizations, ensures accurate coding and claim submission, and mitigates denials. Serving as the primary liaison with insurance carriers, the specialist monitors policy updates, supports contract and pricing alignment, and analyzes reimbursement trends to protect margins. The position collaborates with clinical, billing, finance, and compliance teams to standardize workflows, ensure regulatory compliance, and provide data-driven reporting to support operational and financial decision-making.

Location: Charleston, South Carolina

Entity: Medical University of South Carolina (MUSC - Univ)

Worker Type: Employee

Worker Sub-Type: Classified

Cost Center: CC000991 COM OTO Audiology & Cochlear Implant CC

Pay Rate Type: Hourly

Pay Grade: University-GEN08

Pay Range: $45,300.00 - $77,000.00

Scheduled Weekly Hours: 40

Work Shift: Day (United States of America)

Job Duties:

20% - Reimbursement & Benefits Verification

Verify hearing aid benefits and coverage prior to patient appointments

Interpret commercial, Medicare Advantage, Medicaid, and managed care policies

Determine prior authorization requirements

Estimate patient financial responsibility

Communicate coverage details to patients and clinical staff

20% - Payer Relations & Policy Management

Serve as the primary contact for insurance carriers regarding hearing device coverage

Monitor payer policy updates related to hearing aids and audiology services

Escalate coverage denials and negotiate reconsiderations

Maintain payer-specific coverage guidelines and documentation requirements

Support contract negotiations with managed care organizations (if applicable)

20% - Pricing & Financial Oversight

Monitor manufacturer pricing and reimbursement trends

Ensure hearing aid pricing aligns with payer allowable rates

Analyze margins and reimbursement performance

Provide financial impact analysis for new device lines or payer contracts

15% - Revenue Cycle & Compliance

Ensure correct coding (HCPCS, CPT where applicable)

Support clean claim submission processes

Track denials and identify trends

Develop denial mitigation strategies

Ensure compliance with federal and state regulations governing hearing devices

15% - Data & Reporting Track

Reimbursement turnaround time

Revenue per device

Prepare reports for department leadership

Identify operational improvement opportunities

10% - Collaboration

Work with audiologists and division/department leadership

Revenue cycle / billing department

Compliance office

Finance

Educate providers and staff on payer requirements

Create internal workflows for consistent documentation and authorization practices

Skills Preferred

Strong knowledge of insurance policy interpretation

Understanding of managed care contracts

Familiarity with healthcare coding and reimbursement systems

Analytical and financial acumen

Strong communication and negotiation skills

Regulatory awareness

Minimum Requirements: A high school diploma and three years professional experience in a related area such as accounting, auditing, finance or commercial lending. A bachelor's degree with multiple accounting courses may be substituted for two years of the required work experience.

Physical Requirements: Ability to perform job functions in an upright position. Ability to perform job functions in a seated position. Ability to perform job functions while walking/mobile. Ability to work indoors. Ability to work in confined/cramped spaces. Ability to bend at the waist. Ability to squat and perform job functions. Ability to fully use both hands/arms. Ability to perform repetitive motions with hands/wrists/elbows and shoulders. Ability to reach in all directions. Possess good finger dexterity. Ability to maintain tactile sensory functions. Ability to lift and carry up to 15 lbs., unassisted. Ability to lift objects, up to 15 lbs., from floor level to height of 36 inches, unassisted. Ability to lower objects, up to 15 lbs., from height of 36 inches to floor level, unassisted. Ability to push/pull objects, up to 15 lbs., unassisted. Ability to maintain 20/40 vision, corrected. Ability to see and recognize objects close at hand. Ability to see and recognize objects at a distance. Ability to match or discriminate between colors. Ability to determine distance/relationship between objects; depth perception. Good peripheral vision capabilities. Ability to hear and/or understand conversations. Ability to perform gross motor functions with frequent fine motor movements.

Additional New Requirements: Computer literacy.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.