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

Hearing Aid Reimbursement and Payer Relations Specialist - Department of OtolaryngologyThe 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.Location: Charleston, South CarolinaEntity: Medical University of South Carolina (MUSC - Univ)Worker Type: EmployeeWorker Sub-Type: ClassifiedCost Center: CC COM OTO Audiology & Cochlear Implant CCPay Rate Type: HourlyPay Grade: University-GEN08Pay Range: $45,300.00 - $77,000.000Scheduled Weekly Hours: 40Work Shift: Day (United States of America)Job Duties:20% - Reimbursement & Benefits VerificationVerify hearing aid benefits and coverage prior to patient appointmentsInterpret commercial, Medicare Advantage, Medicaid, and managed care policiesDetermine prior authorization requirementsEstimate patient financial responsibilityCommunicate coverage details to patients and clinical staff20% - Payer Relations & Policy ManagementServe as the primary contact for insurance carriers regarding hearing device coverageMonitor payer policy updates related to hearing aids and audiology servicesEscalate coverage denials and negotiate reconsiderationsMaintain payer-specific coverage guidelines and documentation requirementsSupport contract negotiations with managed care organizations (if applicable)20% - Pricing & Financial OversightMonitor manufacturer pricing and reimbursement trendsEnsure hearing aid pricing aligns with payer allowable ratesAnalyze margins and reimbursement performanceProvide financial impact analysis for new device lines or payer contracts15% - Revenue Cycle & ComplianceEnsure correct coding (HCPCS, CPT where applicable)Support clean claim submission processesTrack denials and identify trendsDevelop denial mitigation strategiesEnsure compliance with federal and state regulations governing hearing devices15% - Data & Reporting TrackReimbursement turnaround timeRevenue per devicePrepare reports for department leadershipIdentify operational improvement opportunities10% - CollaborationWork with:Audiologists and division/department leadershipRevenue cycle / billing departmentCompliance officeFinanceEducate providers and staff on payer requirementsCreate internal workflows for consistent documentation and authorization practicesSkills PreferredStrong knowledge of insurance policy interpretationUnderstanding of managed care contractsFamiliarity with healthcare coding and reimbursement systemsAnalytical and financial acumenStrong communication and negotiation skillsRegulatory awarenessMinimum 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.Physical Requirements: Ability to perform job functions in an upright position. Ability to perform job functions in a seated position.

Ability to perform job functions while walking/mobile. Ability to work indoors. Ability to work in confined/cramped spaces. Ability to bend at the waist. Ability to fully use both hands/arms. Ability to perform repetitive motions with hands/wrists/elbows and shoulders.

Ability to reach in all directions. Possess good finger dexterity. Ability to maintain 20/40 vision, corrected. Ability to see and recognize objects close at hand. Ability to see and recognize objects at a distance. Ability to match or discriminate between colors.

Ability to determine distance/relationship between objects; depth perception. Good peripheral vision capabilities. Ability to hear and/or understand conversations. Ability to perform gross motor functions with frequent fine motor movements.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 and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.