Job Description Summary
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.
Medical University of South Carolina MUSC - UnivWorker TypeEmployeeWorker Sub-TypeClassifiedCost CenterCC000991 COM OTO Audiology & Cochlear Implant CCPay Rate TypeHourlyPay GradeUniversity-GEN08Pay Range45300.00 - 61100.00 - 77000.000Scheduled Weekly Hours40Work ShiftDay United States of America
Job Description
Job Duties
• 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 • 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 • 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 • 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 • Ensure compliance with federal and state regulations governing hearing devices
Data & Reporting Track
• Reimbursement turnaround time • Revenue per device • Prepare reports for department leadership • Identify operational improvement opportunities
Collaboration
• Work with: • Audiologists and division department leadership • Revenue cycle billing department • Compliance office • Finance • Educate providers and staff on payer requirements • Create internal workflows for consistent documentation and authorization practices
Skills Preferred
• 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
Minimum Requirements
A high school diploma and three years professional experience in a related area such as accounting auditing finance or commercial lending. A bachelors degree with multiple accounting courses may be substituted for two years of the required work experience.
Physical Requirements
Note: The following descriptions are applicable to this section
Continuous - 6-8 hours per shift Frequent - 2-6 hours per shift Infrequent - 0-2 hours per shift
Ability to perform job functions in an upright position. Frequent Ability to perform job functions in a seated position. Frequent Ability to perform job functions while walkingmobile. Frequent Ability to work indoors. Continuous Ability to work in confinedcramped spaces. Infrequent Ability to bend at the waist. Infrequent Ability to squat and perform job functions. Infrequent Ability to fully use both handsarms. Continuous Ability to perform repetitive motions with handswristselbows and shoulders. Frequent Ability to reach in all directions. Frequent Possess good finger dexterity. Continuous Ability to maintain tactile sensory functions. Continuous Ability to lift and carry up to 15 lbs. unassisted. Infrequent Ability to lift objects up to 15 lbs. from floor level to height of 36 inches unassisted. Infrequent Ability to lower objects up to 15 lbs. from height of 36 inches to floor level unassisted. Infrequent Ability to pushpull objects up to 15 lbs. unassisted. Infrequent Ability to maintain 2040 vision corrected. Continuous Ability to see and recognize objects close at hand. Continuous Ability to see and recognize objects at a distance. Continuous Ability to match or discriminate between colors. Continuous Ability to determine distancerelationship between objects depth perception. Continuous Good peripheral vision capabilities. Continuous Ability to hear andor understand conversations. Continuous Ability to perform gross motor functions with frequent fine motor movements. Continuous
Additional New Requirements
Computer literacy.
If you like working with energetic enthusiastic individuals you will enjoy your career with us
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race color religion or belief age sex national origin gender identity sexual orientation disability protected veteran status family or parental status or any other status protected by state laws andor federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program please click here http://www.uscis.gov/e-verify-employees