Prior Authorization Specialist

Cochlear Americas is seeking a Prior Authorization Specialist to join our Reimbursement Operations team. As a Prior Authorization Specialist, you will be responsible for facilitating all pre-claim activity for reimbursement orders while providing exceptional service to internal and external customers.

• 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
• 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
• Manage first-level appeals in response to prior authorization denials
• Communicate professionally, effectively, and clearly with customers to ensure understanding and meet the customer need
• Secure in-network exceptions and negotiate one-time agreements with insurance payors in which Cochlear is nonparticipating
• Engage with cross-functional business partners to support reimbursement processes, orders, and customers

• Bachelor's degree 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, and 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

In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits, including 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.