Coordinator, Reimbursement

• Obtains insurance benefit & eligibility and processes prior approvals for patient orders (accessory, processors and surgeries (both standard & revisions) via web portals, email, fax, and phone with adequate performance. Claim submission to health plan, reconciliation of claims, patient invoicing and refunds.
• Works with cochlear implant clinics, surgery centers, Primary Care Providers and all outside medical facilities to obtain applicable medical records to facilitate insurance process for patient orders.
• Acts as the liaison between the patient, the medical professional and health plan(s) to process positive health plan determinations and claim payment for the insurance reimbursement process.
• Research and responds to customer inquiries regarding insurance orders. Including but not limited to, health plan updates, benefit details, patient responsibility of applicable deductible & coinsurance amounts.
• Timely completion and submission of CMS 1500 claim forms via electronic and paper methods as required by payor(s).
• Timely review and correction of all clearinghouse's related issues and rejects.
• Assists the internal customers (Customer Service, Recipient Upgrades, Shipping, Sales) with patient insurance inquiries and insurance prerequisites for prior approval submissions and claim payment
• First level appeals for all denials or any partially paid claims. Including completion of all required forms and submission of all documents needed to support medical necessity.
• Timely follow-up and aggressive recovery of all money due to Advanced Bionics from health carriers and patients.
• Maintains acceptable quality, collection and follow up levels and determined by department goals.
• Other duties as assigned

• High School Diploma

• Minimum of 2 years of experience in health care reimbursement

• 2 years of health care insurance reimbursement experience in eligibility & benefit verification prior approvals and claim processing

• English

• Microsoft Office

• Medical, dental and vision coverage*
• Health Savings, Health Reimbursement, Flexible Spending/Dependent Care Accounts
• TeleHealth options
• 401k plan with company match*
• Company paid life/ad&d insurance

• Additional supplemental life/ad&d coverage available
• Company paid Short/Long-Term Disability coverage (STD/LTD)

• STD LTD Buy-ups available
• Accident/Hospital Indemnity coverage
• Legal/ID Theft Assistance
• PTO (or sick and vacation time), floating Diversity Day, & paid holidays*
• Paid parental bonding leave
• Employee Assistance Program (24/7 mental health support hotline, 5 company paid counseling sessions and more)
• Robust Internal Career Growth opportunities
• Tuition reimbursement
• Hearing aid discount for employees and family
• Internal social recognition platform

Sonova