Prior Authorization Specialist
1 day ago
Cochlear is seeking a skilled Prior Authorization Specialist to join our Reimbursement Operations team. As a key member of our team, you will be responsible for facilitating all pre-claim activity for reimbursement orders while providing exceptional service to internal and external customers.
Key Responsibilities- Verify eligibility and investigate insurance benefits to ensure accurate 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 customer needs
- 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 working with health insurance, including 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
Cochlear offers a competitive salary range of $23.50 - $25.00 per hour, based on experience, as well as an annual bonus opportunity of 5% of base salary. Our benefit package includes 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.
About CochlearCochlear is a global leader in implantable hearing devices, dedicated to helping people with hearing loss experience a life full of hearing. Our employees tell us that the number one reason they enjoy working for Cochlear is the opportunity to make a difference to people's lives and working in an organization where they can be part of bringing the mission to life each day.
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