Prior Authorization Specialist - R-620036_18-7347

$47,840 - $52,000/Yr

Cochlear - Oklahoma City, OK

Full-time - Entry Level

Oklahoma City, OK

Merchant Wholesalers, Durable Goods

About the position

The Prior Authorization Specialist at Cochlear plays a crucial role in facilitating pre-claim activities for reimbursement orders, ensuring exceptional service to both internal and external customers. This position is part of the Reimbursement Operations team, which supports the global leader in implantable hearing devices. The role offers a hybrid or remote work environment and focuses on developing knowledge in health insurance processes while collaborating with various stakeholders to streamline order processes for recipients.

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.
• 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.

Requirements

• 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.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• Disability insurance
• 401(K) matching with immediate vesting
• Paid Time Off
• Tuition reimbursement
• Maternity leave
• Paternity leave
• Employee Stock Purchase Plan
• Pet insurance