UNIV - Hearing Aid Reimbursement and Payer Relations Specialist - Department of Otolaryngology

Medical University of South Carolina • Charleston, SC

1d

About The Position

The Hearing Aid Reimbursement and Payer Relations Specialist manages all aspects of hearing device reimbursement, payer policy oversight, and financial performance. This role verifies insurance benefits, interprets coverage policies, supports prior authorizations, ensures accurate coding and claim submission, and mitigates denials. Serving as the primary liaison with insurance carriers, the specialist monitors policy updates, supports contract and pricing alignment, and analyzes reimbursement trends to protect margins. The position collaborates with clinical, billing, finance, and compliance teams to standardize workflows, ensure regulatory compliance, and provide data-driven reporting to support operational and financial decision-making.

Requirements

• A high school diploma and three years professional experience in a related area such as accounting, auditing, finance or commercial lending.
• A bachelor's degree with multiple accounting courses may be substituted for two years of the required work experience.
• Computer literacy.

Nice To Haves

• Strong knowledge of insurance policy interpretation
• Understanding of managed care contracts
• Familiarity with healthcare coding and reimbursement systems
• Analytical and financial acumen
• Strong communication and negotiation skills
• Regulatory awareness

Responsibilities

• Reimbursement & Benefits Verification: Verify hearing aid benefits and coverage prior to patient appointments, interpret commercial, Medicare Advantage, Medicaid, and managed care policies, determine prior authorization requirements, estimate patient financial responsibility, and communicate coverage details to patients and clinical staff
• Payer Relations & Policy Management: Serve as the primary contact for insurance carriers regarding hearing device coverage, monitor payer policy updates related to hearing aids and audiology services, escalate coverage denials and negotiate reconsiderations, maintain payer-specific coverage guidelines and documentation requirements, and support contract negotiations with managed care organizations (if applicable)
• Pricing & Financial Oversight: Monitor manufacturer pricing and reimbursement trends, ensure hearing aid pricing aligns with payer allowable rates, analyze margins and reimbursement performance, and provide financial impact analysis for new device lines or payer contracts
• Revenue Cycle & Compliance: Ensure correct coding (HCPCS, CPT where applicable), support clean claim submission processes, track denials and identify trends, develop denial mitigation strategies, and ensure compliance with federal and state regulations governing hearing devices
• Data & Reporting: Track Reimbursement turnaround time, Revenue per device, prepare reports for department leadership, and identify operational improvement opportunities
• Collaboration: Work with Audiologists and division/department leadership, Revenue cycle / billing department, Compliance office, and Finance. Educate providers and staff on payer requirements and create internal workflows for consistent documentation and authorization practices

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED