Prior Authorization Specialist Position Available In Mercer, New Jersey

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

Prior Authorization Specialist (Internal title: Reimbursement Operations PreClaim Specialist)

• Deadline to apply: July 7, 2025

Position Spotlight:

• Comprehensive role-based training provided
• Fixed 8-hour shift scheduled within regular business hours (6am-6pm Mountain Time), Monday to Friday, with exact hours adjusted based on the candidate’s time zone
• Hybrid or remote work environment dependent on place of residenceChange people’s lives and love what you do!

Cochlear is helping people hear, and be heard, all over the world and is the most recognized brand in hearing health care.

About the role If you have a passion for working with health insurance providers and are looking for an opportunity to develop your knowledge and grow professionally, this is a fantastic opportunity to join the Reimbursement Operations team at the global leader in implantable hearing devices!

In this role, you will be based in our Americas head office based in Lone Tree, CO. This role offers either a hybrid or remote work arrangement, depending on your place of residence. Candidates in the Denver metro area are required to attend training in person and may transition to a hybrid model based on performance, as evaluated by their supervisor. Those eligible for remote work must live outside the Denver metro area and have a commute to the Lone Tree office deemed excessive. Your daily schedule is a fixed 8-hour shift scheduled within regular business hours (6am-6pm Mountain Time), Monday to Friday, with exact hours adjusted based on your time zone.

Your success in this role is measured by your ability to facilitate all pre-claim activity for reimbursement orders while providing exceptional service to internal and external customers. Work collaboratively with your peers within a region setting where you will develop subject matter expertise, as well as with internal stakeholders in Billing and Collections, Customer Experience and other operations teams to provide the most efficient order process for our recipients.

Key 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
• Navigate and utilize operational resources while managing orders following date and urgency prioritization workflow
• 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
• Communicate professionally, effectively and clearly with customers to ensure understanding and meet the customer need; engage with cross functional business partners to support reimbursement processes, orders and customers
• Secure in network exceptions and negotiate one-time agreements with insurance payors in which Cochlear is non-participatingKey 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
• 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 skillsSalary and Benefits In addition to the opportunity to develop your knowledge and grow professionally, we offer competitive wages and benefits.

Target Salary Range/Rate:

$23.50 – $26.00 per hour based upon experience, as well as an annual bonus opportunity of 5% of base salary. Compensation offered to candidate may vary based on work experience, education and/or skill level.

• 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.

Who are we?

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.

ForTo view the full job description, click hereApply here: https://www.aplitrak.com/?adid=YmJnZW5lcmljLjcwNjc2LjEwNDEyQGNvY2hsZWFyY29tcC5hcGxpdHJhay5jb20