Change people’s lives and love what you do! Cochlear is the most recognized brand in hearing health care.

To be successful in this role the Senior Reimbursement Collections Specialist is responsible for providing exceptional service to all customers (internal and external) by acting with a sense of urgency to perform collection follow-up with government, commercial contracted, and commercial non-contracted insurance carriers and /or patients regarding open accounts receivable and/or delinquent accounts while demonstrating a high degree of knowledge, integrity, and empathy in all aspects of team performance and operations. Primary responsibilities involve billing and collecting payments from health insurance carriers by resolving denials, appealing claims, contacting carriers on open accounts, and responding to insurance carrier correspondence and/or inquiries. The Senior Reimbursement Collections Specialist performs comprehensive review and follow-up activities that facilitate cash collections for Medicaid, Medicare, Commercial Contracted, and Commercial Non-Contracted Insurance accounts.

Key Responsibilities

• Responsible for the portfolio management of health insurance plans deemed to be difficult accounts by upper management; Medicare, Medicaid, other Government Plans, Commercial Contracted, and Commercial Non-Contracted, which will make up greater than 75% of the Senior Reimbursement Collections Specialist  portfolio.  Negotiate settlement agreements with patient and/or payors programs in accordance with Cochlear’s policy and procedures.
• Daily tasks which include but not limited to actively working on all open claims balances and ensure claims are paid according to contract or at the accepted reimbursement dollar amount and ensure claims are processed in accordance with Cochlear’s policy and procedures and in compliance with all federal and state policies. Update patient demographics as necessary to include personal and insurance information on file. Review and resolution of all Brightree, Capario, and Payer electronic claim rejections, review the Brightree unconfirmed report and make corrections to invoices and confirm / resubmit claims for billing. Perform various collection actions including contacting patients by phone, contacting insurance companies for resolution, correcting and resubmitting claims to insurance companies, and filing appeals to have a claim processed for payment if necessary. Analyze and resolve moderately complex insurance denials including, review and follow up on denials within the time frame given by management with the goal of resolving the claim with payment within the timely filing guidelines. Review and recommend write off/adjustments of claims to management as appropriate.
• Performance and General Duties:  Establish working knowledge of Cochlear policies and procedures and understand and navigate Cochlear’s Knowledge Base solutions as a Read Only user. Follow relevant quality procedures in order to deliver quality products and services and identify and support the implementation of continuous improvement. Undertake additional quality responsibilities (e.g. audit) when appropriately trained to undertake these responsibilities. Demonstrate an effective use of workflow efficiencies in reviewing respective portfolio and responsibilities.
• Provide effective coaching for team members as a mentor to improve overall team efficiency and effectiveness and offer guidance and best practices with workflow, daily responsibilities and systems. Assist in training of new employees by providing a welcome and supportive space to continue development while serving in the capacity of their role. Participate in the creation and update of supporting materials, work instructions, and procedures to ensure that the team is across all updates; Participate in educational activities and trainings for personal and professional growth. Contribute ideas on systems and process methods to improve deliverables. Responsible for High Escalation Projects delegated by leadership team.

Key Requirements

To add value to Cochlear in this role you’ll be able to meet and demonstrate the following knowledge, skills and abilities in your application and at interview:

• Bachelors or Equivalent Work Experience
• 7+ Years of Experience
• Ability to understand insurance explanation of benefits
• Must have excellent customer service and phone skills with both internal and external customers
• 1 Year of Cochlear Reimbursement & Insurance Service Experience is preferred 
• Strong computer skills (preferably in Microsoft Suite)
• Proficient experience utilizing common office resources (phone, copier, email)
• Ability to work in a fast paced environment and balance/manage multiple, changing priorities
• Excellent written and verbal communication skills
• Follows through on commitments, meet deadlines, takes responsibility for actions and shows consistency between actions
• In role related tasks, identifies and communicates opportunities for improvement
• Proven ability to work collaboratively and positively in a team environment to build strong, professional relationships ​