Reimbursement Quality Assurance Order Review Specialist

Change people’s lives and love what you do! Cochlear is the most recognized brand in hearing health care. This Reimbursement Quality Assurance Order Review Specialist performs detailed audits of incoming sales orders to ensure accurate and timely processing. About the role This position is based in our Americas head office in LoneTree, CO, and is hybrid—working in the office at least 3 days per week with 2 days per week from home. You will be responsible for upholding the highest level of quality assurance while reviewing product and service orders. Your work will help mitigate the risk of order non‑payment and ensure compliance with all state and federal regulations as orders move from review to shipping, billing, and collections. You will collaborate with Customer Service, Reimbursement Operations, Finance, Reimbursement Billing and Recipient Account Collections, Reimbursement Order Review, and Supply Chain teams. Key Responsibilities Review all Reimbursement Billing Services Orders prior to shipment to ensure accuracy, completeness, and compliance with requirements. Follow the order review process to confirm all payor requirements are met, preventing non‑payment and ensuring claims are billed correctly the first time. Apply Cochlear’s warranty policy and ensure no orders are billed to insurance when the item remains under warranty. Identify, monitor, and address process gaps or issues that arise during the Reimbursement Order Review process, coordinating with the Insurance Service Accreditation and Quality Manager. Document and communicate coaching opportunities and process improvement needs to supervisors and managers. Partner with leaders to implement quality improvement initiatives that meet performance targets. Interpret and apply federal, state, and local coverage guidelines, Medicare and Medicaid rules, payor billing guidelines, and other regulations to all order reviews. Verify eligibility and understand covered benefits by plan—including policy coverage dates, prior authorizations, out‑of‑network agreements, coordination of benefits, co‑insurance payments, and expected reimbursement per fee schedules, contracts, and billing guides. Key Requirements High school diploma or GED. Minimum 1 year of experience with compliance regulations related to medical billing (HIPAA and CMS guidelines). Experience with Medicaid and Medicare reimbursement processes and procedures. Ability to check durable medical equipment (DME) orders for completeness and compliance with state, federal, and local laws. 2–3 years of active use of Microsoft Excel, with an emphasis on detailed spreadsheet understanding. Total Rewards Pay range: $27.00–$30.00 per hour, based on experience, with an annual bonus opportunity of 5% of base salary. Benefits include medical, dental, vision, life and disability insurance, 401(K) matching with immediate vesting, paid time off, tuition reimbursement, maternity and paternity leave, an Employee Stock Purchase Plan, and pet insurance. Physical & Mental Demands Requires a stationary (seated or standing) position and the use of business technology. Communication skills—both oral and written—are essential. Occasional lifting of up to 30 pounds may be required. Reasonable accommodations can be made for disabilities. Equal Opportunity Statement Cochlear Americas is an Equal Opportunity Employer. We will provide reasonable accommodations for qualified individuals with disabilities. If you require assistance completing the online application, please contact us at View phone number on click.appcast.io. #J-18808-Ljbffr C20 Cochlear Americas (USA)