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Cochlear · 1 month ago

Prior Authorization Specialist

Lone Tree, Colorado

Full-time

Hybrid

Entry, Mid Level

$23.50/hr - $26/hr

2+ years exp

Cochlear is the most recognized brand in hearing health care, helping people hear and be heard worldwide. The Prior Authorization Specialist will facilitate pre-claim activities for reimbursement orders while providing exceptional service to customers and collaborating with internal teams.

Health CareMedical Device

Responsibilities

Verify eligibility, investigate insurance benefits and validate coverage; calculate and collect recipient out of pocket estimates based on their deductible, coinsurance and out of pocket maximum

Navigate and utilize operational resources while managing orders following date and urgency prioritization workflow

Collect documentation based on payor requirements and medical professional preferred method

Evaluate medical documentation for accuracy, requirements and validity and submit to insurance for prior authorization when required

Communicate professionally, effectively and clearly with customers to ensure understanding and meet the customer need; engage with cross functional business partners to support reimbursement processes, orders and customers

Secure in network exceptions and negotiate one-time agreements with insurance payors in which Cochlear is non-participating

Qualification

Insurance VerificationPrior AuthorizationCoordination of BenefitsOut of Pocket CalculationsMicrosoft OfficeVerbal CommunicationWritten CommunicationTeam Collaboration

Required

Bachelors or Equivalent Work Experience

2-3 years of experience ideally working with health insurance, including but not limited to: Insurance Verification, Prior Authorization, Coordination of Benefits, Out of Pocket cost estimate calculations

Proven ability to work collaboratively and positively in a team environment to build strong, professional relationships

Excellent computer skills (preferably in Microsoft Office) and experience utilizing common office resources (phone, fax, copier and email)

Excellent verbal and written communication skills