Reimbursement Quality Assurance Order Review Specialist Change people's lives and love what you do at Cochlear—the most recognized brand in hearing health care—helping people hear and be heard around the world, while being part of one of Denver Business Journal's 2026 Best Places to Work honorees in Denver. This position will be responsible for upholding the highest level of quality assurance in accurately reviewing product and service orders. This role ensures the highest mitigation of the risk of order non-payment and compliance with all state and federal regulations and laws as orders transition from order review to shipping and billing and collections. Working collaboratively with Customer Service, Reimbursement Operations, Finance, Reimbursement Billing and Recipient Account Collections, Reimbursement Order Review, and Supply Chain team members, this role also ensures timely completion of all reimbursement order reviews. In this role, you will be based in our Americas head office in Lone Tree, CO. This role is hybrid, requiring you to be in the office 3 days per week minimum, with 2 days per week working from home.
Key Responsibilities:
Review all Reimbursement Billing Services Orders prior to shipment to ensure accuracy, completion, and compliance requirements are met. Responsible for following the order review process to ensure that all payor requirements have been met before orders are released to ensure a clean claim billed the first time and to mitigate the risk of non-payment; including understanding Cochlear's warranty policy and reviewing all orders to ensure that no orders are billed to insurance where the item is still under warranty. Responsible for identifying, monitoring, escalating, and solutioning process gaps in the order fulfillment process and issues requiring coaching of team members that are found during the Reimbursement Order Review process in coordination with the Insurance Service Accreditation and Quality Manager. Document and communicate to relevant supervisors and managers coaching opportunities and issues identified. Partner with leaders to implement improvements to process with quality assurance advisements that ensure specified coaching needs are directed effectively to improve overall performance and efficiency aligned with quality assurance thresholds and performance targets. Responsible for understanding and following federal, state, and local agency coverage, Medicare and Medicaid guidelines, payor specific billing guidelines and regulations and using this understanding as a baseline for all order reviews. Responsible for eligibility verification and understanding of covered benefits by plan, including active policy coverage dates, Prior-authorizations, OTAs, COBs, co-insurance payments, and expected reimbursement according to applicable fee schedules, contracts, and billing guide stipulations and requirements.
Key Requirements:
High school diploma or GED1+ year(s) working with compliance regulations associated with medical billing (HIPAA and CMS guidelines), experienced with Medicaid and Medicare reimbursement processes and procedures, ability to check DME orders for completeness and compliance with state, federal and local laws 2-3 years of actively using Microsoft Excel with an emphasis on understanding spreadsheet details
Total Rewards:
In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits. Pay Range in the United States: $27.00/hr - $30.00/hr based upon experience, as well as an annual bonus opportunity of 5% of base salary. Exact compensation may vary based on skills, experience, and location. 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. Human needs have always been our inspiration, ever since Professor Graeme Clark set out to create the first multi-channel cochlear implant because he saw his father struggle with hearing loss. We always start with people in mind – thinking about their needs. For this reason, our products, services and support will continue to evolve and improve. We are by our customers' side through the entire hearing journey, so they can 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. The physical and mental demands described below are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the individual is regularly required to be in a stationary (seated/standing) position; utilize business technology for work product delivery, communicate orally and in writing with others internal or external to the organization, utilize problem solving/critical thinking skills to discern and convey information. May be asked to occasionally transport/move up to 30 pounds, depending on the position. Specific vision abilities required by this job include ability to adjust focus. The individual is regularly required to utilize comprehension, critical thinking, communication, problem solving, organization reasoning, relating to others and discernment of items such as product specifications, procedures and processes to customers (whether internal or external). Influence, organization/classification of information and planning are also required. The work environment is a home/office environment. This is representative of the environment an individual may encounter while performing the essential functions of this job.
